Juvenile nasopharyngeal angiofibroma: efficacy of radiation therapy.

Abstract

From 1962 to 1984, 13 patients with juvenile nasopharyngeal angiofibroma (JNA) were treated with megavoltage radiation therapy. Follow-up ranged from 40 to 255 months (median, 136 months). Two patients received radiation therapy as the initial treatment; the other 11 patients had undergone unsuccessful previous surgical treatment (median, three resections). Gross tumor was evident at the start of radiation therapy in seven patients, and orbital, sphenoid sinus, or intracranial extension was noted in eight of 13 (62%). Doses ranged from 3,600 to 5,200 cGy (median, 4,800 cGy in daily fractions of 180-200 cGy). Tumor was controlled in 11 patients (85%) after irradiation. Two patients were treated with embolization for residual mass; both remained asymptomatic and without evidence of tumor 134 and 83 months after embolization, respectively. With the exception of xerostomia and caries, no significant chronic morbidity was seen. This review and other studies demonstrate that megavoltage radiation therapy is an effective and appropriate treatment for advanced and recurrent JNA; its routine use for early tumors remains controversial.

Multisession Cyberknife radiosurgery for the treatment of advanced-stage intracranial extended Juvenile nasopharyngeal angiofibrom

“…There is a consensus in the literature that advanced disease with radiographic evidence of intracranial extension or those lesions seemed incompletely resectable without significant morbidity can be efficaciously treated with external-beam RT with acceptable morbidity [1][2][4][5][6][7][8][9][10][11]. A significant concern related to RT is late toxicity, such as second malignancy [7], hypopituitalism [1,7], cataract formation [1-2, 4, 7, 11], optic neuropathy or retinopathy, dental caries secondary to the xorostomia [8], and nasal dryness and crusting. Excellent local tumor control and considerably reduced morbidity as compared with the older radiotherapy series can be obtained in conformal radiotherapy series [5][6]9].…”

“…For large tumors 1 2 with intracranial extension, the potential for surgical morbidity is very high because of their relation to major vasculature and cranial nerves at the base of the skull, and it may still leave residual disease needing postoperative RT [1][2]4]. The RT had been used as the primary modality of treatment for extensive lesions with good control rates with acceptable morbidity [1][2][4][5][6][7][8][9][10][11]. We present a case of advanced staged huge JNA that was treated by multisession CKRS with a volume fractionated technique.…”

Complete resolution of stage IIIB juvenile nasopharyngeal angiofibroma with radiation therapy

“…Although radiation has been reported to be an effective measure of therapy for JNA [1,5,6,7,8,9,10,11], potential long term complications have discouraged many from pursuing this course of therapy. Thyroid carcinoma, bone and soft tissue sarcomas, basal cell carcinoma, hypopituitarism, cataract, osteoradionecrosis, optic nerve, atrophy, osteomyelitis of skull base, facial growth retardation in maturing adolescents, all have been reported by various authors [6,[10][11][12][13][14].…”

“…Intracranial involvement has been reported to occur in 10-30 % of all cases with middle cranial fossa being the most common sites of intracranial extension [3,4]. Significant morbidity and even death may occur from intra cranial extension or haemorrhage [5].…”

Angiofibroma nasofaríngeo: revisão de literatura

“…A Figura 1 mostra esquematicamente o ponto de origem do tumor e suas rotas de expansão. Alguns autores acreditam que esse crescimento tecidual anômalo deve-se à elevação dos níveis de andrógenos mediados por receptores hormonais específicos localizados no tecido tumoral 5,8 . A partir do seu ponto de origem o tumor começa, então, seu crescimento por debaixo da mucosa estendendo-se inicialmente à porção posterior da cavidade nasal e teto da rinofaringe.…”