Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
Auris Nasus Larynx. 2022 Dec;49(6):1019-1026. doi: 10.1016/j.anl.2022.03.020. Epub 2022 Mar 24.
Head and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital.
The patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund-Mackay (LM) staging system.
In total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020).
We found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.
头颈部手术可能会导致鼻气流发生变化，而放射治疗会不可逆地损伤副鼻窦上皮细胞。一些化疗药物已被报道会使小鼠气道纤毛活动受到负面影响，而慢性鼻-鼻窦炎可能是头颈部癌症（HNC）治疗的一种不良反应。为了评估 HNC 治疗是否是导致可能反映副鼻窦炎症的鼻-鼻窦黏膜增厚的危险因素，我们比较了在一家大学医院接受治疗的 HNC 患者治疗前后的鼻窦计算机断层扫描（CT）图像。
本研究纳入了 2015 年 1 月至 2019 年 12 月期间接受 HNC（口腔、咽和喉癌）根治性治疗并开始接受一线治疗的患者。从病历中分析了患者的年龄、性别、原发灶、临床分期、治疗方法、吸烟史、饮酒史、合并症（糖尿病和慢性肺部疾病）以及治疗前后（最后一次治疗后三个月和一年）的鼻窦 CT 图像。使用 Lund-Mackay（LM）分期系统对治疗前后的鼻窦 CT 图像进行评分。
共有 245 名患者参与了这项研究。在最后一次治疗后三个月，80.4%的患者总 LM 评分没有变化（p=0.621）。几乎 80%接受全喉切除术的患者总 LM 评分也没有变化（p=0.833）。15 例鼻咽癌（NPC）患者中有 3 例治疗后 LM 评分更差（5/15），但无显著差异（p=0.171）。收集的各种因素均与治疗完成后三个月 LM 评分的变化无显著相关性。最后一次治疗后一年，纳入了 211 名患者，在相同的分析中，LM 评分的前后无显著变化，而 LM 评分在 T 分期（T1-2 与 T3-4）之间有显著差异（p=0.020）。
我们发现，所有患者的 LM 评分在 HNC 治疗后均无显著变化，这表明 HNC 治疗可能不是鼻-鼻窦黏膜炎症的明显危险因素。
