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Review Papers | Otorhinolaryngology | Saudi Arabia | Volume 12 Issue 12, December 2023
Management of Nasal Complications after Irradiation of Head and Neck Cancers - A Literature Review
Ahmed Alsayed | Moath A Alfaleh
Abstract: Nasopharyngeal carcinoma (NPC) constitutes a mere 0.7% of all reported cancers globally. Neoplasms affecting the nasal and paranasal sinus regions are infrequent and represent a small fraction of head and neck cancers. While radiation therapy is pivotal in treating head and neck cancers, it can induce mucosal damage, resulting in severe complications during and after treatment, including common side effects like rhinosinusitis and alterations in smell. Advancements in radiotherapy techniques, transitioning from 3D - conformal planning to intensity - modulated radiation therapy (IMRT), signify notable progress. This review zeroes in on nasal complications arising from radiotherapy in head and neck cancer patients, encompassing sinonasal mucosal disorders, olfactory disturbances, choanal atresia, and synechia. A thorough literature review, incorporating databases like PubMed, Embase, Cochrane, and Scopus, identified 5736 papers, with 46 meeting eligibility criteria. After a meticulous full - text assessment, 30 articles were included in qualitative synthesis, while 16 were excluded for various reasons. The review underscores that the incidence and severity of olfactory dysfunction and chronic rhinosinusitis peak at the conclusion of radiotherapy and three months post - treatment, gradually diminishing over time. Procedures like Functional Endoscopic Sinus Surgery (FESS) and interventions involving fluticasone propionate aqueous nasal spray coupled with irrigation have demonstrated efficacy in mitigating symptoms and improving the quality of life for nasopharyngeal carcinoma patients grappling with post - irradiation rhinosinusitis. Additionally, endoscopic surgeries have reported favorable outcomes in addressing sinonasal complications, including chronic sinusitis and choanal stenosis. For nasopharyngeal stenosis (NPS) ensuing from radiation treatment, endoscopic excision and carbon dioxide laser excision with balloon dilation have displayed success rates of 80 - 100% and 40 - 60%, respectively. In conclusion, the management of nasal complications post - irradiation necessitates early identification and treatment through surgical and endoscopic approaches.
Keywords: nasal complications, review, irradiation, Nasopharyngeal carcinoma, rhinosinusitis, synechia, head and neck cancer
Edition: Volume 12 Issue 12, December 2023,
Pages: 981 - 989