Patient-Reported Symptoms: A Crucial Aspect of Skull Base Osteoradionecrosis Assessment and Monitoring

Lirit Levi; Amir Levi; Michael T. Chang; Jayakar Nayak; Zara M. Patel; Quynh-Thu Le; Juan C. Fernandez-Miranda; Peter H. Hwang

doi:10.1055/s-0045-1803909

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803909

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Patient-Reported Symptoms: A Crucial Aspect of Skull Base Osteoradionecrosis Assessment and Monitoring

Authors

Lirit Levi

¹Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, United States
Amir Levi

²Department of Physiology, University of California, San Francisco, California, United States
Michael T. Chang

¹Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, United States
Jayakar Nayak

¹Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, United States
Zara M. Patel

¹Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, United States
Quynh-Thu Le

³Department of Radiation Oncology, Stanford University, Stanford, California, United States
Juan C. Fernandez-Miranda

⁴Department of Neurosurgery, Stanford University, Stanford, California, United States
Peter H. Hwang

¹Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, United States

Abstract

Full Text

Introduction: Skull base osteoradionecrosis (SBORN) is a severe complication in patients receiving radiation therapy for head and neck cancers. Monitoring SBORN traditionally involves assessing patients’ symptoms, endoscopic findings, imaging studies, and inflammatory serum markers. This study aims to evaluate the quality of life (QOL) in these patients and investigate the correlation between SBORN monitoring markers and Sinonasal Outcome Test (SNOT-22), a patient-reported QOL questionnaire.

Methods: A retrospective chart review was conducted on patients diagnosed with SBORN between 2009 and 2024, managed at our tertiary referral sinus center. Data collection included demographics, cancer diagnosis and treatment modalities. SBORN treatment, outcomes, and mortality data were recorded as well. For each visit, records included patients’ symptoms, endoscopic scores (crusting, scaring, polyp, edema and discharge), SNOT-22 scores, ESR and CRP. Correlation coefficients (cc) and Partial rank correlation coefficients (PCC) were calculated to analyze the correlation between SNOT-22 scores and other SBORN monitoring measurements, controlling for the number of visits. SBORN was considered stable when patients showed clinical improvement without requiring further systemic or surgical treatment throughout the rest of the follow-up period.

Results: A total of 20 patients with a total of 344 visits were included in the study. Of these patients, 70% were male, and 55% were of Asian ethnicity. NPC was the predominant cancer diagnosis (80%), with 45% of patients undergoing reirradiation. SBORN developed on average 7 ± 8 years after radiation treatment, and the follow-up time was 7 ± 5 years. The most frequently reported symptoms were pain and crusting. The mean SNOT-22 score was 33.8 (range: 0–102). Overall, SNOT-22 scores showed significant correlations with endoscopic scores and ESR (PCC = 0.23, pv = 0.0053 and PCC = 0.49, pv = 0.004). CRP did not correlate with SNOT-22. All SNOT-22 domains significantly correlated with endoscopic scores, with the highest correlation seen in the sleep dysfunction domain (cc = 0.29, pv = 0.0004). The sleep and psychological dysfunction domains were strongly correlated with ESR (cc = 0.58, pv = 0.0014 and 0.53, pv = 0.0004). Mean SNOT-22 score was lower in patients who eventually achieved stable SBORN compared with those who continue to progress (20.5 vs. 40.9, p = 0.037).

Conclusion: Patients with SBORN can experience significant symptoms, and given the chronic nature of their disease, their QOL should be considered. Our study demonstrates that SBORN has a substantial impact on patient QOL, and SNOT-22 can be a valuable tool for physicians in assessing SBORN progression and treatment efficacy, given its correlation with both inflammatory markers and endoscopic assessments. However, there is a need for the development of a disease-specific QOL questionnaire tailored to this unique patient population.

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