Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy
by
, , , and
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 Lin
6,
Bing-Shen Huang
6,
Shih-Wei Yang
2,3,
Chi-Che Huang
1,3,
Po-Hung Chang
1,3,
Ta-Jen Lee
1,*
and
Joseph Tung-Chieh Chang
6,* 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
*
Authors to whom correspondence should be addressed.
Cancers 2022, 14(1), 225; https://doi.org/10.3390/cancers14010225
Submission received: 20 October 2021
/
Revised: 30 November 2021
/
Accepted: 9 December 2021
/
Published: 4 January 2022
(This article belongs to the Special Issue Application of Proton Beam Therapy in Cancer Treatment)
Simple Summary
Chronic rhinosinusitis (CRS) is a common treatment complication in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. In this study, we aimed to investigate the incidence and severity of CRS in NPC patients who underwent intensity-modulated proton therapy (IMPT) by evaluating the sinus mucosa change in imaging studies, and we compared these patients with those who underwent volume-modulated arc therapy (VMAT). This was a retrospective case–control study in which 53 and 54 patients were treated with IMPT and VMAT, respectively. We noted that patients in the IMPT group had a significantly lower incidence and decreased severity of sinus mucosa abnormality than those with VMAT. Better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed. IMPT techniques deposit the bulk of their radiation doses in highly confined areas, allowing lower exposure of non-target organs during irradiation, which results in more sinonasal mucosa being retained.
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.
