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

Pei-Wen Wu; Chien-Chia Huang; Yun-Shien Lee; Yung-Chih Chou; Kang-Hsing Fan; Chien-Yu Lin; Bing-Shen Huang; Shih-Wei Yang; Chi-Che Huang; Po-Hung Chang; Ta-Jen Lee; Joseph Tung-Chieh Chang

doi:10.3390/cancers14010225

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

Cancers (Basel). 2022 Jan 4;14(1):225. doi: 10.3390/cancers14010225.

Authors

Pei-Wen Wu^{1

2}, Chien-Chia Huang^{1

3}, Yun-Shien Lee^{4

5}, Yung-Chih Chou^{6

7}, Kang-Hsing Fan^{6

7}, Chien-Yu Lin⁶, Bing-Shen Huang⁶, Shih-Wei Yang^{2

3}, Chi-Che Huang^{1

3}, Po-Hung Chang^{1

3}, Ta-Jen Lee¹, Joseph Tung-Chieh Chang⁶

Affiliations

¹ Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333, Taiwan.
² Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung 204, Taiwan.
³ Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
⁴ Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
⁵ Department of Biotechnology, Ming Chuan University, Taoyuan 333, Taiwan.
⁶ Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333, Taiwan.
⁷ Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan.

Abstract

In the past decade, patients with nasopharyngeal cancer (NPC) have been deemed candidates for proton radiotherapy, due to the large and comprehensive target volumes and the necessity for the retention of the surrounding healthy tissues. In this study, we aimed to compare the incidence and severity of post-irradiation sinusitis by detecting sinus mucosa diseases (SMDs) via the magnetic resonance imaging (MRI) of patients with NPC after intensity-modulated proton therapy (IMPT) and volume-modulated arc therapy (VMAT). A total of 53 patients in the IMPT group and 54 patients in the VMAT group were enrolled in this study. There were significantly lower endoscopic scores and Lund-Mackay staging scores determined from MRI scans in the IMPT group during different follow-up periods. For the most vulnerable sinuses, the incidence and severity of SMD were the highest during the third post-radiotherapy month in both groups. These decreased steadily, and there was no significant increase in the incidence and severity of SMD during the second post-radiotherapy year in the IMPT group. Our data show that NPC patients with IMPT have a significantly lower incidence and decreased severity of SMD than those with VMAT. A better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed.

Keywords: nasopharyngeal carcinoma; post-irradiation sinusitis; proton therapy; sinus mucosa disease.