Zheng Chunge, Yu Longgang, Jiang Yan
Department of Otolaryngology, Head and Neck Surgery The Affiliated Hospital of Qingdao University Qingdao Shandong Province China.
Otorhinolaryngology Head and Neck Surgery Key Laboratory of Shandong Province Qingdao Shandong Province China.
World J Otorhinolaryngol Head Neck Surg. 2023 Sep 4;10(4):324-332. doi: 10.1002/wjo2.134. eCollection 2024 Dec.
Radiation-induced rhinosinusitis is a vital dose-limiting reaction in patients with head and neck malignancy. Unlike oral mucositis during or after radiotherapy, radiation-induced sinusitis is easily overlooked in clinical practice and rarely included in experimental studies. Herein, we review the literature to date on radiation-induced rhinosinusitis.
Relevant studies published between 1995 and 2022 were determined through a detailed search using open keywords from PubMed, with manual search of the reference list of the identified articles. Keywords searched were "ionizing radiation," "radiotherapy," "intensity-modulated radiotherapy," "head and neck tumor," "nasopharyngeal carcinoma," "nasal epithelium," "radiation damage," and "radiation-induced rhinosinusitis." Full-text articles that clearly stated the pathogenesis, clinical manifestation, predictors, treatment, and prognosis of radiation-induced rhinosinusitis were included.
Radiation-induced rhinosinusitis occurs during radiotherapy and can last for months or even years after radiotherapy. A mixture of cellular outcomes caused by ionizing radiation and persistent damage of the epithelial and submucosal tissues after the treatment result from the radiotherapy itself. Endoscopic sinus surgery improves symptoms but can be accompanied by intraoperative and postoperative complications. Nasal irrigation, steroids, and antibiotics appear to reduce inflammation and relieve symptoms to a certain extent. Studies on other potentially useful drugs are underway and in the exploration stage, without clinical application.
Despite its high incidence, radiation-induced rhinosinusitis is a type of dose-limiting toxicity that theoretically does not produce fatal effects at controlled doses and with adequate follow-up care. In moderate-to-severe cases, toxicity may be present. Currently, radiation-induced rhinosinusitis has potential prevention and treatment strategies. However, no unified management protocol has shown significant improvement in radiation-induced rhinosinusitis. Further research is necessary.
放射性鼻窦炎是头颈部恶性肿瘤患者重要的剂量限制反应。与放疗期间或放疗后的口腔黏膜炎不同，放射性鼻窦炎在临床实践中容易被忽视，且很少纳入实验研究。在此，我们回顾了迄今为止关于放射性鼻窦炎的文献。
通过使用来自PubMed的开放关键词进行详细检索，并人工检索已识别文章的参考文献列表，确定1995年至2022年间发表的相关研究。检索的关键词为“电离辐射”“放射治疗”“调强放射治疗”“头颈部肿瘤”“鼻咽癌”“鼻黏膜上皮”“辐射损伤”和“放射性鼻窦炎”。纳入明确阐述放射性鼻窦炎发病机制、临床表现、预测因素、治疗和预后的全文文章。
放射性鼻窦炎在放疗期间发生，放疗后可持续数月甚至数年。放疗本身导致电离辐射引起的一系列细胞反应以及治疗后上皮和黏膜下组织的持续损伤。鼻内镜鼻窦手术可改善症状，但可能伴有术中及术后并发症。鼻腔冲洗、类固醇和抗生素似乎能在一定程度上减轻炎症并缓解症状。关于其他潜在有用药物的研究正在进行且处于探索阶段，尚未应用于临床。
尽管放射性鼻窦炎发病率高，但它是一种剂量限制毒性，理论上在控制剂量并给予充分随访护理的情况下不会产生致命影响。在中重度病例中，可能存在毒性。目前，放射性鼻窦炎有潜在的预防和治疗策略。然而，尚无统一的管理方案能显著改善放射性鼻窦炎。有必要进一步开展研究。
