Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas.
BACKGROUND
Juvenile nasopharyngeal angiofibromas (JNAs) with significant skull base involvement and intracranial extension are challenging tumors. We evaluated our experience in the treatment of extensive JNAs through resection followed by radiosurgery.


METHODS
From 1999 to 2007, 10 advanced JNAs (Andrews grade IV) were treated by primary surgical resection followed by gamma knife radiosurgery of residual tumor. Tumor control and treatment morbidity were evaluated.


RESULTS
Six months after radiosurgery and annually thereafter, an imaging study was done that revealed decrement in tumor size in 3 patients and no change in 7 patients, after a 3-year minimum follow-up. Clinically, patients are asymptomatic.


CONCLUSIONS
An efficient strategy in the management of extensive JNAs is the use of a multimodality approach, in which surgical resection is followed by the treatment with radiosurgery in critical locations. These therapeutic schemes are safe and offer long-term tumor control.
Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. flopez_1981@yahoo.es
Fernando López
FL
Álvarez
Vanessa
V
Suárez
Carlos
C
Suárez
José L
JL
Llorente
D000293:Adolescent; D000367:Age Factors; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009305:Nasopharynx / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D019292:Skull Base Neoplasms / Q000556:secondary / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome