Cerebrospinal Fluid Leak in Juvenile Nasopharyngeal Angiofibroma—Rare Sequelae of Flutamide-Induced Tumor Shrinkage

Panda, Smriti; Phalak, Manoj; Thakar, Alok; Dharanipathy, Sundarakrishnan

doi:10.1016/j.wneu.2018.07.288

Cited by 11 publications

(14 citation statements)

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“…These effects were described as a result of systemic testosterone receptor blockade during treatment and resolved following treatment termination. Patient follow‐ups displayed no long‐term adverse effects of treatment concerning secondary sexual characteristics, sexual function, or bone mineral density 6–8 . Although testosterone levels during flutamide treatment regimens increased across all studies, follow‐up testing of patients showed testosterone stabilization after the regimens had ended.…”

Section: Discussionmentioning

confidence: 92%

“…Patients were grouped into either the prepubertal or postpubertal group based upon pretreatment testosterone levels provided by cited studies to examine the extent of suggested variation in the therapeutic effects of flutamide according to the patients' pubertal status 7,8 . Postpubertal males were those patients exhibiting secondary male gender characteristics with serum testosterone levels at or above 1.95 ng/ml, while prepubertal males were those without the onset of sexual maturity with serum testosterone concentrations at or below 0.30 ng/ml 7 .…”

Section: Resultsmentioning

confidence: 99%

“…Flutamide treatment regimens also varied between studies and analysis reveals that a flutamide regimen of 125 mg QID for 6 weeks resulted in the largest average reduction in tumor volume. There is not a standard flutamide dosing regimen in the treatment of JNA, which may have contributed to the differences in tumor volume reduction in the analyzed studies 6–8 . Prolonging flutamide treatment past 6 weeks may elicit even greater volume reducing effects 7 .…”

Section: Discussionmentioning

confidence: 99%

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The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

Sitenga

Granger

Hepola³

et al. 2021

Int J Dermatology

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Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare but potentially lifethreatening fibrovascular tumor that is seen almost exclusively in adolescent males and usually presents with symptoms of nasal obstruction or severe epistaxis. The current gold standard of treatment consists of complete surgical resection; however, this is inherently challenging because of the tumor's invasive nature and a substantial risk of intraoperative hemorrhage. Flutamide, an anti-androgen antineoplastic agent, has been used preoperatively in attempts to reduce tumor volume allowing for surgical resection with more conservative procedural techniques and reduce intraoperative blood loss.Methods A literature review of PubMed and CINAHL was used to identify and analyze 29 male patients with JNA to determine the efficacy of the preoperative use of flutamide. ResultsOur analyses indicate that flutamide may be effective as a neoadjuvant agent by reducing tumor volume prior to resection in some patients but seemed to be more effective in the early stages of JNA without advanced tumor invasion. However, individual tumor response to flutamide was variable. Additionally, postpubertal patients seemed to demonstrate a greater reduction in tumor volume with flutamide compared to their prepubertal counterparts. Dosing regimen and side effects associated with flutamide therapy are also discussed. ConclusionFlutamide may be an effective neoadjuvant therapy in some cases of juvenile nasopharyngeal angiofibroma, but larger scale, case-control studies are likely needed to further expand on this conclusion. Postpubertal males with early-stage disease seemed to be the population that may benefit most from this treatment protocol.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

Sitenga

Granger

Hepola³

et al. 2021

Int J Dermatology

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“…Pre‐surgical flutamide treatment for tumor shrinkage in post‐pubertal males 22,23 is routinely used at our institution, particularly for advanced‐stage tumors. In stage III tumors, administration of flutamide did not affect the DOTANOC uptake ( P = .42).…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

et al. 2020

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Objectives/Hypothesis Somatostatin receptors (SSTRs) are highly expressed in neuroendocrine tumors and is exploited for its imaging and treatment. SSTRs expression is also demonstrated in diverse benign and malignant tumor cell types and proliferating peri‐tumoral vessels. Similarly, Juvenile Nasopharyngeal Angiofibroma (JNA) expresses different SSTRs and may be utilized for its imaging and treatment using DOTA, 1‐Nal3‐octreotide (DOTANOC)‐PET/CT scan. Study Design Prospective cohort. Methods Nineteen clinico‐radiologically diagnosed primary JNA patients underwent a 68Ga‐DOTANOC PET‐CT scan. Using a dedicated PET/CT scanner, a low‐dose head and neck spot CT scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi(74–111 MBq) of DOTANOC. The primary objective was to assess the intensity and pattern of DOTANOC uptake in these patients. Results DOTANOC expression was noted in all cases (n = 19) of primary JNA (100%). The mean (SD) DOTANOC SUVmax ratio of tumor and background was 6.9+/−1.4(range, 3.8–9.5). Intra‐cranial extension in all 13/19 patients was prominently visualized due to the absence of DOTANOC uptake in the brain. Compared to the background all stages of JNA showed significant DOTANOC uptake (P < .0001). No difference in uptake between advanced‐stage tumors and early tumors was noted (P = .47). A statistically non‐significant negative trend was noted for decreasing uptake with increasing age (Spearman correlation coefficient, r = −0.19). Conclusions This first study of 68Ga‐DOTANOC‐PET/CT scan in JNA demonstrates consistent and reliable uptake activity in all patients irrespective of age and stage. This opens up possibilities to physiological diagnostic imaging with a promise of greater specificity and sensitivity and may have applications in ambivalent diagnostic situations such as the detection of recurrence. Level of Evidence 3 Laryngoscope, 131:1509–1515, 2021

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“…Описаны офтальмоплегия и субатрофия зрительного нерва [112], спонтанный разрыв интракавернозного тракта внутренней сонной артерии при ЮАН большого размера [113]. Ликворея также описана в качестве осложнения при лечении ЮАН флутамидом [114], послеоперационных кровотечениях и травматизации верхнечелюстного нерва [104].…”

Section: рисунокunclassified

Juvenile nasopharyngeal angiofibroma

Краснов

Грачёв

Vorozhtsov

et al. 2020

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor that affects almost exclusively male adolescents. Usually, symptoms of JNA are detected within 15–24 months before seeking medical help. JNA is mainly diagnosed in patients aged 14 to 25 years. Angiofibroma consists of a complex mixture of blood vessels and a fibrous stroma. This feature of their structure determines the property of the tumor to bleed massively even after minimal surgical procedures. The tumor usually grows posteriorly and upward, involving the sphenoid sinus. Under certain circumstances, it can spread anteriorly into the nasal cavity with the involvement of ethmoid cells. With lateral spread, it affects the space of the pterygo-palatine fossa and can also spread into the infratemporal fossa through the expanded pterygo-maxillary fissure, into the region of the chewing muscles and soft tissues of the cheek. In this review, we briefly outline the study history, and current aspects of etiology, pathogenesis, diagnostic and treatment methods of JNA.

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Cerebrospinal Fluid Leak in Juvenile Nasopharyngeal Angiofibroma—Rare Sequelae of Flutamide-Induced Tumor Shrinkage

Cited by 11 publications

References 11 publications

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

Juvenile nasopharyngeal angiofibroma

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Cerebrospinal Fluid Leak in Juvenile Nasopharyngeal Angiofibroma—Rare Sequelae of Flutamide-Induced Tumor Shrinkage

Cited by 11 publications

References 11 publications

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

68Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

Juvenile nasopharyngeal angiofibroma

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⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study