Post-radiation sinusitis is associated with recurrence in nasopharyngeal carcinoma patients treated with intensity-modul
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RESEARCH
Open Access
Post-radiation sinusitis is associated with recurrence in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy Chih-Jen Huang1,2, Ming-Yii Huang1,2, Ming-Chen Paul Shih3,4, Kai-yuan Cheng5, Ka-Wo Lee5, Tzu-Ying Lu1,2, Shyng-Shiou Yuan6 and Pen-Tzu Fang1,2*
Abstract Background: This study investigated the impact of post-radiation sinusitis on the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). Methods: Two hundred and thirty patients with non-metastatic NPC were analyzed in terms of freedom from local failure (FFLF), freedom from distant failure (FFDF), overall survival (OS), and disease-free survival (DFS). For each patient, the status of the sinus mucosa was flexibly assessed by documenting mucosal changes as indicated by differences between images obtained before radiotherapy and more than 6 months post-radiation. Results: With a median follow-up of 39.7 months (8 to 81 months), 19 (8.26%) patients relapsed locally, 13 (5.65%) patients failed in the neck, and 26 (11.3%) patients developed distant metastases. The presence of sinusitis noted in images post-radiation was a significant predictor for DFS (p = 0.001), FFLF (p = 0.004), and FFDF (p = 0.015), in addition to having high negative predictive value for local relapse (97.5%). Conclusions: This is the first study to investigate the prognostic value of post-radiation sinusitis in NPC patients treated with IMRT. Post-radiation sinusitis was found to be a significant predictor for DFS, FFLF, and FFDF, and was also found to have high negative predictive value for local recurrence (97.5%). It may thus be used as an additional tool for clinicians to determine the possibility of recurrence. Keywords: Nasopharyngeal carcinoma, Intensity-modulated radiation therapy, Post-radiation sinusitis, Recurrence
Background Nasopharyngeal carcinoma (NPC) is a common cancer in Taiwan and Southeast Asia. For early stage NPC, the standard treatment is radiotherapy (RT) alone. For the advanced stage of the disease, a combination of chemotherapy and RT is necessary [1]. Due to advances in RT techniques, improvements in treatment outcomes have been achieved. In the past decade, intensity-modulated radiotherapy (IMRT) has been proven to be a more * Correspondence: [email protected] 1 Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan 2 Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Full list of author information is available at the end of the article
effective means of treating NPC than conventional RT [2, 3]. This breakthrough technique allows dose escalation to the tumor and delivers a highly conformal dose distribution in treating NPC. Therapeutic gains have been achieved by simultaneously improving local control and reducing RT-related toxicity. Clinicians are making ongoing efforts to discover useful prognostic factors in this new IMRT
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