Endoscopic sequestrectomy for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: a 10‑year experience

Liu, Juan; Ning, Xianhui; Sun, Xicai; Lu, Hanyu; Gu, Yurong; Wang, Dehui

doi:10.1007/s10147-018-1354-8

Cited by 27 publications

(40 citation statements)

References 18 publications

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“…The best treatment protocol for sphenoid ORN still remains to be determined. An overall survival rate of 54% has been reported by Liu et al with a surgical management through an endoscopic approach . Other authors have reported on open approaches with free flaps .…”

Section: Discussionmentioning

confidence: 94%

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Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Daoudi

Labeyrie

Guillerm

et al. 2020

Laryngoscope Investig Oto

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Objective Osteoradionecrosis (ORN) of the sphenoid is a rare but potentially lethal complication that can occur after irradiation of nasopharyngeal and clival malignancies. The objective of this study was to describe a multimodal treatment strategy tailored to the clinical signs and to the radiological extent of the disease, and to report on its preliminary results. Methods Retrospective monocentric study at a tertiary skull base center. Patients treated for a sphenoid ORN from January 2014 to August 2018 were identified and charts were retrospectively reviewed for demographics, histologic tumor type, previous treatments of the tumor, clinical signs at presentation, radiological data, treatment, and outcomes. Sphenoid ORN was treated by a combination of medical therapy, endovascular treatment, and/or surgery. The use of each of these therapeutic modalities was based on the extent of ORN and on the presenting signs. Results Seven patients were included: four patients underwent endovascular treatment with occlusion of the internal carotid artery, five patients underwent surgical debridement, and covering of the exposed bone by a local flap, seven patients received antibiotics (in combination with pentoxyphilline, tocopherol, and clodronate in one case). Three patients died after progression of the ORN. The global survival rate was 57% (4/7) with a mean follow‐up of 24 months. In one case, ORN was treated successfully by medical treatment only, with a combination of antibiotics, pentoxyphilline, tocopherol, and clodronate. Conclusion This retrospective study describes the results of a management strategy adapted to the extent of the disease in sphenoid ORN and based on medical therapy only, or on a combination of medical therapy, interventional radiology, and/or surgery. Level of evidence 4

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Section: Discussionmentioning

confidence: 94%

“…et al with a surgical management through an endoscopic approach 8. Other authors have reported on open approaches with free flaps 3.…”

mentioning

confidence: 99%

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Daoudi

Labeyrie

Guillerm

et al. 2020

Laryngoscope Investig Oto

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“…The pooled resolution rate of 64% identified in this analysis is in agreement with the literature showing that ESBS is an effective treatment approach for skull base ORN, providing adequate access and reconstructive options. [1][2][3][6][7][8][9][10] However, there was significant heterogeneity in the data, which may be attributed to the fact that the a priori definitions of efficacy were inconsistent between studies. Examples of efficacy measures included Sino-Nasal Outcome Test (SNOT-22) scores, 9 mucosal healing and re-epithelialization of tissue flaps, 6,7 and overall survival.…”

Section: Discussionmentioning

confidence: 99%

“…Examples of efficacy measures included Sino-Nasal Outcome Test (SNOT-22) scores, 9 mucosal healing and re-epithelialization of tissue flaps, 6,7 and overall survival. 8 Notably, several studies reported worse outcomes in patients who underwent multiple courses of radiotherapy due to local NPC recurrence. [1][2][3]7,8 In the largest study included in this analysis, multiple radiotherapy courses was an independent negative predictor of overall survival after ESBS (p = 0.026), with a mortality rate 3.2-fold higher than for patients with a single course.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of postradiation skull base osteoradionecrosis

Spillinger

Park

Shenouda

et al. 2020

Int Forum Allergy Rhinol

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How to Cite this Article Spillinger A Park K Shenouda K Folbe AJ Endoscopic management of postradiation skull base osteoradionecrosis Int Forum Allergy Rhinol-Osteoradionecrosis (ORN) of the skull base is a rare but potentially life-threatening complication after radiotherapy in the treatment of nasopharyngeal carcinoma (NPC). It portends a poor prognosis, mainly due to risk of exsanguination from internal carotid artery (ICA) rupture. 1 Limited data exist regarding the use of conservative therapies, such as hyperbaric oxygen, tocopherol, and pentoxifylline, and surgery remains the mainstay treatment. 2,3 Despite the major role of surgery in managing skull base ORN, there exists a paucity of literature regarding experiences with endoscopic endonasal approaches. The objective of this study was to perform a systematic review and metaanalysis to synthesize experiences with endoscopic skull base surgery (ESBS) and determine resolution and complication rates.

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“…Post-RT adverse events in patients with NPC involving the central nervous system, including radiation encephalopathy, diffuse white matter injury, and optic neuritis, have been welldescribed (3). Osteoradionecrosis (ORN), with an incidence of 10.1%, is also a common complication after RT; it frequently develops in the mandible, maxilla, and skull base (4)(5)(6). Nevertheless, ORN in the cervical spine has been regarded as a rare complication, although the cervical vertebrae are often included in the irradiation field (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Differentiation of Cervical Spine Osteoradionecrosis and Bone Metastasis After Radiotherapy Detected by Bone Scan in Patients With Nasopharyngeal Carcinoma: Role of Magnetic Resonance Imaging

Zhong

et al. 2020

Front. Oncol.

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Background: Osteoradionecrosis (ORN) of the cervical spine is a serious complication after radiotherapy (RT), which may show increased radiotracer uptake on a bone scan (BS) and be mistaken as metastasis. We aimed to assess the value of magnetic resonance imaging (MRI) in the differentiation of cervical spine ORN from bone metastasis after RT detected by BS in nasopharyngeal carcinoma (NPC). Methods: In this retrospective study, 35 NPC patients who had undergone RT were enrolled, of whom 21 patients showed cervical spine ORN and 14 showed bone metastasis. New areas of increased radiotracer uptake in the cervical spine on a BS were noted in all patients, following which the patients underwent neck MRI for further assessment. Two radiologists independently reviewed two sets of images including a BS set and an MRI set (MRI with BS) and reached a consensus. The diagnostic sensitivity, specificity, and accuracy for ORN detection were calculated, and interobserver agreement was evaluated using the kappa test. Results: A total of 75 cervical spine lesions were identified (44, ORN; 31 metastases). The BS set analysis showed that the diagnostic sensitivity, specificity, and accuracy were only 38.6, 48.3, and 42.7%, respectively, for differentiation of cervical spine ORN from bone metastasis. On the other hand, the MRI set analysis showed that the diagnostic sensitivity, specificity, and accuracy increased to 86.4, 90.3, and 88.0%, respectively. The interobserver agreement for the MRI set was determined to be very good (κ = 0.92). Conclusion: MRI is a reliable technique for the further discrimination of emerging cervical spine lesions after RT detected by BS. Furthermore, it could be a better differential diagnosis technique for distinguishing ORN from metastasis and may help avoid a wrong assignment of the patient to a metastatic stage with indication for treatment with supplemental toxicity and a subsequent palliative strategy.

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Endoscopic sequestrectomy for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: a 10‑year experience

Cited by 27 publications

References 18 publications

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Endoscopic management of postradiation skull base osteoradionecrosis

Differentiation of Cervical Spine Osteoradionecrosis and Bone Metastasis After Radiotherapy Detected by Bone Scan in Patients With Nasopharyngeal Carcinoma: Role of Magnetic Resonance Imaging

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