| Summary: | 碩士 === 中國醫藥大學 === 醫學研究所碩士班 === 95 === Background: Nasopharyngeal carcinoma (NPC) is the second common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. RT-induced rhinosinusitis is a common side effect in post-irradiated NPC patients. Nasal irrigation is frequently recommended for treatment of post-RT rhinosinusitis. To our knowledge, there was no study related to this subject till now. The purpose of this study was to find the RT effect on the paranasal sinuses in patients with NPC, including the incidence and the timing course. And we try to evaluate the efficacy of nasal irrigation for RT-induced rhinosinusitis.
Materials and Methods: A retrospective study was preformed first for estimate the incidence of IMRT-induced rhinosinusitis in our institute and the timing course of sinus mucosal change in the first post-treatment year. Patients who received full course RT for NPC and had 4 times CT scans at baseline, post RT 3months, 6 months and 12 months in our hospital were retrospectively recruited from January 2002 to June 2004. From October 2004 to May 2006, patients with NPC were consecutively recruited. Patients who did not complete RT, who had residual or recurrent nasopharyngeal tumor during the study period, and who lost to follow-up after RT were excluded. All patients were randomly allocated to irrigation or non-irrigation groups. Patients in irrigation group received daily nasal irrigation till 6 months after RT. The endoscopy and questionnaire scores were recorded at baseline (the week before radiotherapy), at 4th week of RT, at the week RT completed and at post-RT 1, 2, and 3, 6 and 12months.
Results: Fifty patients with NPC were enrolled for the retrospective study. The CT scores rose after RT and gradually decreased at post-RT 6 months. The CT scores at post-RT 12 months remained slightly higher than the baseline. It seemed the RT effect on paranasal sinuses had acute and late phases. The prospective study designed under this hypothesis enrolled 107 patients with NPC: When patients were grouped as irrigation or non-irrigation, patients in the irrigation group had lowered endoscopic and questionnaire scores than patients in non-irrigation group. Significant differences between two groups were observed when including all follow-up points till post-RT 6 months both in endoscopic and questionnaire scores (p=0.0001 and 0.0012, respectively). The between-group differences were most obvious at post-RT 2 and 3 months. However, the mean endoscopic and questionnaire scores decreased to near the baseline level at post-RT 12 months, both in irrigation and non-irrigation groups.
Conclusions: The results of this study confirmed that rhinosinusitis was a common RT side effect in patients with NPC. With the advances of radiotherapy technique, most IMRT-induced rhinosinusitis improved after 6 months. Nasal irrigation was proved as a safe and effective management for relief the acute post-RT nasal symptoms.
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