Sinonasal Side Effects of Chemotherapy and/or Radiation Therapy for Head and Neck Cancer: A Literature Review

Abstract

Radiotherapy and chemotherapy represent important treatment modalities for head and neck cancer. Rhinosinusitis and smell alterations are common side effects in the sinonasal region. This review will summarize and analyze our current knowledge of the sinonasal side effects of chemotherapy and/or radiation therapy for head and neck cancer (HNC), with a specific focus on mucosal and olfactory disorders. A review of the English literature was performed using several databases (PubMed, Embase, Cochrane, Scopus). Fifty-six articles were included in qualitative synthesis: 28 assessed mucosal disorders (rhinitis or rhinosinusitis), 26 evaluated olfactory alterations, and 2 articles addressed both topics. The incidence and severity of olfactory dysfunction and chronic rhinosinusitis were highest at the end of radiotherapy and at three months after treatment and decreased gradually over time. Smell acuity deterioration and chronic rhinosinusitis seemed to be related to radiation dose on olfactory area and nasal cavities, but different degrees of recovery were observed. In conclusion, it is important to establish the severity of chronic rhinosinusitis and olfactory dysfunction in order to find strategies to support patients and improve their quality of life.

Impact of long‐term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients

“…In addition, although statistically insignificant, the TL group contained a marginally greater proportion of patients who underwent radiation therapy or chemotherapy after surgery. The detrimental effects of chemotherapy and radiotherapy on nasal ciliary clearance and sinus function, along with alterations in the sinonasal mucosa ranging from congestion to atrophic changes, have been documented in numerous recent publications, as this may have possibly been one of the confounding factors in our study 37–40 . However, considering that the main reason for TL is mostly due to advanced laryngopharyngeal cancers, the effects of additional chemoradiation on the sinonasal mucosa and microstructures should be considered as the major limitation.…”

“…in numerous recent publications, as this may have possibly been one of the confounding factors in our study. [37][38][39][40] However, considering that the main reason for TL is mostly due to advanced laryngopharyngeal cancers, the effects of additional chemoradiation on the sinonasal mucosa and microstructures should be considered as the major limitation. To overcome this factor, a subgroup analysis regarding on the adjuvant chemo-or radiation status might be fruitful.…”

Nasal Cytology Changes in Head and Neck Cancer Treatment: A Systemic Review

“…Late toxicities (tissue changes occurring at least 90 days after RT end) are represented by osteoradionecrosis, xerostomia, fibrosis, thyroid dysregulation, sensorineural hearing loss, myelitis, and pharyngeal or laryngeal stenosis [32][33][34]. In the sinonasal district, due to the dysregulation of nasal mucociliary clearance (MCC), RT is responsible for a variety of disruptions and alterations [35].…”

“…Furthermore, Cooper et al demonstrated that late clinically relevant alterations rarely occurred with doses lower than 50 Gy, while oral and nasal ulcerations were extremely rare for doses < 65 Gy [36]. In a recent review, the percentage of patients affected by CRSr ranged from 7% to 86.1%, and the most common pathogens isolated in the CRSr group were Staphilococcus aureus, Streptococcus viridans, and Pseudomonas aeruginosa [35]. Moreover, Stoddard et al found that Staphilococcus aureus and Pseudomonas aeruginosa represented the most common bacteria in sinonasal cultures of patients affected by CRSr and concluded that the bacteriology of CRSr seemed to be similar to the usual microorganism colonization of non-radiated patients [28].…”

Editorial for the Special Issue on Multimodality and Sequential Therapy in Locally Advanced Head and Neck Cancer

“…These side effects seemed to be related to radiation dose on the olfactory area and nasal cavities, but different degrees of recovery were observed. Therefore, it became important to establish the severity of chronic rhinosinusitis and olfactory dysfunction in order to find strategies to support patients and improve their quality of life [ 6 ].…”