Sinonasal Morbidity Following Chemoradiation in Nasopharyngeal Carcinoma Patients

Background and Purpose: The majority of nasopharyngeal carcinomas are treated by radiation therapy. Some of the common sinonasal complications in these patients are sinusitis, crusting, and adhesions. The objective of the study was to determine the risk factors for sinonasal morbidity patients of NPC post chemoradiotherapy.

Methods: A single center, retrospective chart review of patients who underwent radiation therapy treatment for nasopharyngeal carcinoma between 2015–2019 was performed. Patients were evaluated for complications of sinusitis, adhesions, and crusting.

Results: 43 patients were included in the study. Mean age at presentation was 56 ± 14.6 years and majority were males (83.3%). The mean total dose of radiation was 68.5 ± 6.4 Gy, and mean fraction of radiation treatment was 35 ± 6.1. Average duration of follow up was 20.1 ± 14.5 months.

20 patients (46.5%) had at least 1 of the sinonasal complications analyzed – either crusting, sinusitis or adhesions - following radiation treatment. Six patients (14.0%) required treatment for sinusitis at 5.4 ± 5.3 months after completion of radiation treatment. Of those treated, 3 were treated with antibiotics and 3 received FESS.

Three patients (7.0%) experienced adhesions requiring treatment at 5.3 ± 5.8 months after completion of radiation treatment. Sinusitis was found to be 75 times more likely in patients who developed adhesions (p = 0.002, OR = 75.00, 95% CI: 3.18–1766.46).

Eight patients (18.6%) experienced extensive nasal crusting that required debridement and crusting was noted to present at average 7.1 ± 4.0 months after completion of radiation treatment. All patients with crusting were able to be debrided in-office.

We did not observe any significant correlation between sinusitis, adhesions, or crusting and groups stratified by: gender, race, age, smoking history, primary vs recurrent tumor, tumor skull base involvement, pterygopalatine invasion, infratemporal fossa invasion, xerostomia, chemotherapy treatment, radiotherapy treatment, fractions of radiation, radiation dosage, immunotherapy treatment, EBV status, p16 status, TNM stage, or 30 day readmission. Crusting did not correlate with either adhesions or sinusitis.

Conclusions: Sinonasal morbidity—either crusting, adhesions, or sinusitis—are seen in one in 5 patients of NPC following chemoradiotherapy. The majority of these complications are seen at 6.1 ± 4.5 months following treatment completion. Although none of the patient or tumor related factors are a reliable predictor of sinonasal morbidity, development of adhesions increased the risk of development of sinusitis 75-fold.