Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3004-8
Rhinology
Factors influencing the incidence of sinusitis in nasopharyngeal carcinoma patients after intensity‑modulated radiation therapy Yan‑xia Su · Lan‑ping Liu · Lei Li · Xu Li · Xiu‑juan Cao · Wei Dong · Xin‑hua Yang · Jin Xu · Shui Yu · Jun‑fang Hao
Received: 27 October 2013 / Accepted: 4 March 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract The aim of the study was to investigate the incidence of sinusitis in nasopharyngeal carcinoma (NPC) patients before and after intensity-modulated radiation therapy (IMRT) and to analyze factors associated with the incidence of sinusitis following IMRT. We retrospectively analyzed 283 NPC patients who received IMRT in our hospital from March 2009 to May 2011. The diagnostic criteria for sinusitis are based on computed tomography (CT) or magnetic resonance imaging (MRI) findings. CT or MRI scans were performed before and after IMRT to evaluate the incidence of sinusitis. Factors influencing the incidence of sinusitis were analyzed by log-rank univariate and logistic multivariate analyses. Among the 283 NPC patients, 128 (45.2 %) suffered from sinusitis before radiotherapy. The incidence rates of sinusitis in patients with T1, T2, T3, and T4 NPC before radiotherapy were 22.6, 37.5, 46.8, and 61.3 %, respectively (χ2 = 14.548, p = 0.002). Among the 155 NPC patients without sinusitis before radiotherapy, Y. Su · L. Liu · X. Cao · W. Dong · X. Yang · J. Xu · S. Yu · J. Hao (*) The Ninth Clinical Department of Radiation Oncology, Shandong Tumor Hospital, 440 Jiyan Road, Jinan 250117, People’s Republic of China e-mail: [email protected] Y. Su School of Medicine and Life Sciences, University of JinanShandong Academey of Medical Sciences, Jinan, People’s Republic of China L. Li The Department of PET‑CT Center, Shandong Tumor Hospital, Jinan, People’s Republic of China X. Li The Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, People’s Republic of China
the incidence rates of sinusitis at the end of radiotherapy and at 1, 3, 6, 9, 12, and 18 months after radiotherapy were 32.9, 43.2, 61.3, 68.4, 73.5, 69.7, and 61.3 %, respectively (χ2 = 86.461, p 3 mm) with effusion or an air–fluid level in the sinus cavity and (2) an enhanced scan showing a thickened and strengthened sinus mucosa, without an indication of bone erosion [8]. The diagnostic criteria for MRI include the following: (1) mucosal thickening on enhanced scans (the mucosa has a low signal or a signal on T1WI and a high signal on T2WI) and (2) sinus effusion or an air–fluid level in the sinus cavity (effusion has a low signal on T1WI and a very high signal on T2WI) [9]. However, the signal for inflammatory thickening of the mucosa is less than that of an effusion. An effusion in the sinus cavity is not reinforced in enhanced scanning.
The incidence of sinusitis before radiotherapy Among the 283 patients, 128 (45.2 %) had sinusitis before IMRT. Maxillary sinusitis was found in 95 patients (163 sides), ethmoid sinusitis in 71 patients (115 groups), and sphenoid sinusitis in 82 patients (131 sides). According to the 7th edition of the UICC/AJCC staging system, the incidence of sinusitis from T1 to T4 is shown in Table 1. There was a highly significant difference in the incidence of sinusitis in different T stages (χ2 = 14.548, p = 0.002). Thus, there was a positive association between the incidence of sinusitis and T stage among NPC patients before radiotherapy.
Statistical analysis All statistical analyses were performed using the SPSS 17.0 software package (Chicago, IL, USA). The Chisquare test (χ2 test) was used for rate comparisons. Univariate analysis was used to analyze the correlations of age, sex, TNM stage, T stage, N stage, invasion of nasal cavity, nasal irrigation, chemotherapy, and dose of radiotherapy with the occurrence of sinusitis after IMRT. Multivariate analysis with a logistic regression model was used to screen the factors influencing the occurrence of sinusitis after IMRT. A p value 50 years TNM stage II III IV T classification T1 T2 T3 T4 N classification N0 N1 N2 N3 Invasion of the nasal cavity Yes No Nasal irrigation Yes No Chemotherapy Yes No Nasopharyngeal exposure dose ≥72 Gy
Rhinology
Factors influencing the incidence of sinusitis in nasopharyngeal carcinoma patients after intensity‑modulated radiation therapy Yan‑xia Su · Lan‑ping Liu · Lei Li · Xu Li · Xiu‑juan Cao · Wei Dong · Xin‑hua Yang · Jin Xu · Shui Yu · Jun‑fang Hao
Received: 27 October 2013 / Accepted: 4 March 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract The aim of the study was to investigate the incidence of sinusitis in nasopharyngeal carcinoma (NPC) patients before and after intensity-modulated radiation therapy (IMRT) and to analyze factors associated with the incidence of sinusitis following IMRT. We retrospectively analyzed 283 NPC patients who received IMRT in our hospital from March 2009 to May 2011. The diagnostic criteria for sinusitis are based on computed tomography (CT) or magnetic resonance imaging (MRI) findings. CT or MRI scans were performed before and after IMRT to evaluate the incidence of sinusitis. Factors influencing the incidence of sinusitis were analyzed by log-rank univariate and logistic multivariate analyses. Among the 283 NPC patients, 128 (45.2 %) suffered from sinusitis before radiotherapy. The incidence rates of sinusitis in patients with T1, T2, T3, and T4 NPC before radiotherapy were 22.6, 37.5, 46.8, and 61.3 %, respectively (χ2 = 14.548, p = 0.002). Among the 155 NPC patients without sinusitis before radiotherapy, Y. Su · L. Liu · X. Cao · W. Dong · X. Yang · J. Xu · S. Yu · J. Hao (*) The Ninth Clinical Department of Radiation Oncology, Shandong Tumor Hospital, 440 Jiyan Road, Jinan 250117, People’s Republic of China e-mail: [email protected] Y. Su School of Medicine and Life Sciences, University of JinanShandong Academey of Medical Sciences, Jinan, People’s Republic of China L. Li The Department of PET‑CT Center, Shandong Tumor Hospital, Jinan, People’s Republic of China X. Li The Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, People’s Republic of China
the incidence rates of sinusitis at the end of radiotherapy and at 1, 3, 6, 9, 12, and 18 months after radiotherapy were 32.9, 43.2, 61.3, 68.4, 73.5, 69.7, and 61.3 %, respectively (χ2 = 86.461, p 3 mm) with effusion or an air–fluid level in the sinus cavity and (2) an enhanced scan showing a thickened and strengthened sinus mucosa, without an indication of bone erosion [8]. The diagnostic criteria for MRI include the following: (1) mucosal thickening on enhanced scans (the mucosa has a low signal or a signal on T1WI and a high signal on T2WI) and (2) sinus effusion or an air–fluid level in the sinus cavity (effusion has a low signal on T1WI and a very high signal on T2WI) [9]. However, the signal for inflammatory thickening of the mucosa is less than that of an effusion. An effusion in the sinus cavity is not reinforced in enhanced scanning.
The incidence of sinusitis before radiotherapy Among the 283 patients, 128 (45.2 %) had sinusitis before IMRT. Maxillary sinusitis was found in 95 patients (163 sides), ethmoid sinusitis in 71 patients (115 groups), and sphenoid sinusitis in 82 patients (131 sides). According to the 7th edition of the UICC/AJCC staging system, the incidence of sinusitis from T1 to T4 is shown in Table 1. There was a highly significant difference in the incidence of sinusitis in different T stages (χ2 = 14.548, p = 0.002). Thus, there was a positive association between the incidence of sinusitis and T stage among NPC patients before radiotherapy.
Statistical analysis All statistical analyses were performed using the SPSS 17.0 software package (Chicago, IL, USA). The Chisquare test (χ2 test) was used for rate comparisons. Univariate analysis was used to analyze the correlations of age, sex, TNM stage, T stage, N stage, invasion of nasal cavity, nasal irrigation, chemotherapy, and dose of radiotherapy with the occurrence of sinusitis after IMRT. Multivariate analysis with a logistic regression model was used to screen the factors influencing the occurrence of sinusitis after IMRT. A p value 50 years TNM stage II III IV T classification T1 T2 T3 T4 N classification N0 N1 N2 N3 Invasion of the nasal cavity Yes No Nasal irrigation Yes No Chemotherapy Yes No Nasopharyngeal exposure dose ≥72 Gy
