Primary radiation therapy for juvenile nasopharyngeal angiofibroma

Abstract

Evidence is presented of the effectiveness and relative lack of serious toxicity of external beam megavoltage radiation therapy (RT) as primary treatment for juvenile nasopharyngenl angiofibroma. The importance of careful radiological evaluation of tumor extent prior to irradiation is stressed, and only moderate dose RT is required. Fifty‐five patients have been treated by RT and followed for from 3 to 26 years. Forty‐four of 55 patients (80%) had permanent tumor control following a single course of 3000 cGy to 3500 cGy over 3 weeks. Surgical resection or a second course of RT controlled the tumor in all 11 patients in whom regrowth occurred. Angiofibromas involute slowly after RT so that 50% of patients still had visible masses in the nasopharynx 12 months after treatment, but only 10% had any visible abnormality 36 months after RT. Retreatment was necessary only if symptoms recurred, and continued follow‐up showed that most asymptomatic nasopharyngeal masses resolved completely. Acute and late toxicity rates were low. Two patients developed tumors in the head or neck following RT. There was no significant clinical impairment of growth or endocrine function. A single course of external beam megavoltage radiation to 3000 cGy in 3 weeks is an effective first treatment for patients with juvenile nasopharyngeal angiofibroma.

Management of Juvenile Nasopharyngeal Angiofibroma: A Five Year Retrospective Study

“…Radiotherapy with 35 Gy was administered to case no. 1 post operatively to deal with left out intracranial extension of JNA which slowly regressed there after a period of 1 year [12].…”

Endoscopic approach to juvenile nasopharyngeal angiofibroma: our experience at a tertiary care centre

“…29 Primary radiation therapy for angiofibroma, at doses of 3000 -3500 cGy, has been considered in a few centres. 27 Recent advancements in technology and techniques have made endoscopic excision of angiofibroma possible. Based on the experience of endoscopic sinus surgery and transnasal endoscopic vidian neurectomy, Kamel first suggested endoscopic transnasal surgery for angiofibroma in 1996.…”

Juvenile nasopharyngeal angiofibroma: current treatment modalities and future considerations

“…Patients with intracranial involvement, unresectable disease, religious preferences, or multiple recurrences may be good candidates for radiation treatment [43]. Liu et al [44] reported 2 patients with stage IV incompletely resected tumors who were given 30 Gy and 40 Gy, respectively without recurrent at 1 and 6 years.…”

“…In addition to these risks, panhypopituitarism, temporal lobe necrosis, cataracts and radiation keratopathy may be precipitated by conventional radiation treatment in patients in JNA. Recurrence rate of 20-30% can be expected with radiation treatment alone [1,43,46]. Harwood et al [47] concluded that surgery and radiation carry comparable risks, but that morbidity and mortality risks associated with surgery should be considered.…”