Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Wu, Pei‐Wen; Cc, Huang; Lee, Yun‐Shien; Chou, Yi–Hong; Fan, Kang‐Hsing; Lin, Ching-Yi; Huang, Bing‐Shen; Yang, Shih‐Wei; Huang, Chi‐Che; Chang, Phei‐Lang; Lee, Ta‐Jen; Chang, Joseph Tung-Chieh

doi:10.3390/cancers14010225

Cited by 14 publications

(8 citation statements)

References 35 publications

(47 reference statements)

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“…Secondly, the anatomical characteristics of the sinuses have a great impact on the occurrence of sinusitis after RT, while the anatomical variations of the paranasal sinuses were similar in the patients with different radiotherapy modalities. However, our results are not consistent with those of Pei-Wen et al, which may require further prospective studies to con rm [43].…”

Section: Radiotherapy Modalitycontrasting

confidence: 99%

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Zheng

Yan

Liu

et al. 2023

Preprint

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Objective: To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients. Patients and methods:A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS. Results: (1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: F=6.542, p=0.009 vs. non-sinusitis before RT group: F=11.702, p=0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: F=0.458, p=0.766 vs. non-sinusitis before RT group: F=0.500, p=0.736). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p=0.000, time after RT: p=0.008 and TNM staging: p=0.040). Conclusion: (1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.

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Section: Radiotherapy Modalitycontrasting

confidence: 99%

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Zheng

Yan

Liu

et al. 2023

Preprint

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“…Chronic rhinosinusitis (CRS) is one of the major treatment complications of radiotherapy in patients with NPC. [27][28][29] Our recent studies on IRinduced CRS show that there was a significant decreased expression level of MUC5AC and MUC5B (secretary proteins of goblet cells), α-tubulin and FOXJ1 (ciliated cells) as well as aberrant proliferation of p63+KRT5+ basal cells in NPC patients after 2-7 years of radiotherapy. 15,17 These findings indicate radiotherapy may cause long-term defects to the nasal epithelium structure.…”

Section: Discussionmentioning

confidence: 99%

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro

Yang¹,

Liu²,

Liu³

et al. 2022

JIR

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Purpose Radiotherapy (RT) is the mainstay treatment for head and neck cancers. However, chronic and recurrent upper respiratory tract infections and inflammation have been commonly reported in patients post-RT. The underlying mechanisms remain poorly understood. Method and Materials We used a well-established model of human nasal epithelial cells (hNECs) that forms a pseudostratified layer in the air-liquid interface (ALI) and exposed it to single or repeated moderate dose γ-irradiation (1Gy). We assessed the DNA damage and evaluated the biological properties of hNECs at different time points post-RT. Further, we explored the host immunity alterations in irradiated hNECs with polyinosinic-polycytidylic acid sodium salt (poly [I:C]) and lipopolysaccharides (LPS). Results IR induced DNA double strand breaks (DSBs) and triggered DNA damage response in hNECs. Repeated IR significantly reduced basal cell proliferation with low expression of p63/KRT5 and Ki67, induced cilia loss and inhibited mucus secretion. In addition, IR decreased ZO-1 expression and caused a significant decline in the transepithelial electrical resistance (TEER). Moreover, hyperreactive response against pathogen invasion and disrupted epithelial host defense can be observed in hNECs exposed to repeated IR. Conclusion Our study suggests that IR induced prolonged structural and functional impairments of hNECs may contribute to patients post-RT with increased risk of developing chronic and recurrent upper respiratory tract infection and inflammation.

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“…Post-radiation sinusitis incidence in patients with NPC receiving IMRT was 45.2–47% [ 6 , 12 ] within one year after treatment. In long-term follow-up, the rate of post-radiation sinus mucosal change peaked at 3–6 months and stabilized within a year [ 19 , 27 ]. The longest follow-up in these studies was up to five years after RT.…”

Section: Discussionmentioning

confidence: 99%

Worsening Rhinosinusitis as a Prognostic Factor for Patients with Nasopharyngeal Carcinoma: A Retrospective Study

Lin¹,

Kuo

Hsu

et al. 2022

Biomedicines

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Rhinosinusitis is common in patients with nasopharyngeal carcinoma (NPC). Our study aimed to explore the role of rhinosinusitis severity in NPC prognosis. Medical records and radiologic examinations of 90 patients with NPC at a single medical center from 2009–2016 were retrospectively analyzed. The Lund–Mackay (L–M) score was obtained for each patient before and after 6 months of treatment. Rhinosinusitis diagnosis was based on L–M scores of ≥4. L–M score differences were calculated as pre-treatment rhinosinusitis (PRRS) minus post-treatment rhinosinusitis (PSRS). L–M score difference was sub-grouped into “L–M scores > 0”, “L–M scores = 0”, and “L–M scores < 0”. Clinical staging of our patients based on the American Joint Committee on Cancer 7th edition were: stage I in nine, stage II in seventeen, stage III in twenty-two, and stage IV in forty-two patients; twenty-seven (30%) patients had died. PRRS incidence was 34.4%, and PSRS was 36.7%. Median of L–M scores difference was 0 (−2.2). L–M score difference was an independent prognostic factor for the overall survival of patients with NPC (p < 0.05). Therefore, worsening rhinosinusitis was a prognostic factor for patients with NPC. Clinicians should consider NPC as a warning sign of poor prognosis during routine follow-ups.

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Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Cited by 14 publications

References 35 publications

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro

Worsening Rhinosinusitis as a Prognostic Factor for Patients with Nasopharyngeal Carcinoma: A Retrospective Study

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