Scientific Online Resource System

International Bulletin of Otorhinolaryngology

Case Report of Advanced Juvenile Nasopharyngeal Angiofibroma with Cavernous Sinus Involvement: Advantages of Advanced Radiotherapy Thechnique Volumetric Modulated Arc Therapy

E. Encheva, Hr. Ivanovska, N. Sapundzhiev, G. Iliev, V. Kaleva, Hr. Hristozova, M. Milkov

Abstract

Objectives: In very advance unresectable stages Juvenile nasopharyngeal angiofibroma (JNA)radiotherapy is treatment of choice. Usually JNA is in close proximity to different organ at risk, which necessitates accurate and precise radiation delivery. Series reported the application of IMRT (Intensity Modulated Radiotherapy) with good sparing of organ at risk, but the literature search found no report on VMAT (Volumetric Modulated Arc Therapy) treatment in case of JNA.
Clinical case: The present publication report for first time a patient irradiated with VMAT and IGRT (Image guided radiotherapy) for JNA. The stage of the tumor based on CT and MRI was IIIB according to Radkovsi with cavernous sinus invasion. Moderate total radiation dose 36 Gy in 1.8 Gy per fraction was delivered. No early and late toxicity was recorded. The patient is followed up every six months and persistent residual tumor on MRI was seen, but no bleeding onphysical exam. At one year follow up this is accepted as good local control.
Conclusion: VMAT and IGRT could be safely applied with reduction of the radiation dose at organ of risk. VMAT is promising in the treatment of juvenile angiofibroma with advantages over conventional radiotherapy, but as this is case report of only one patient, further experience with VMAT is needed in JNA

Keywords

Advanced juvenile nasopharyngeal angiofibroma, treatment, radiotherapy, VMAT, IGRT

Full Text


References

Wiatrak BJ, Koopman CF, Turrisi AT. Radiation therapy as an alternative to surgery in the management of intracranial juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 1993; 28:51–61

Gullane PJ, Davidson J, O’Dwyer T, et al. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992; 102:928–933.

Patterson CN. Juvenile nasopharyngeal angiofibroma. Otolaryngol Clin North Am 1973; 6:839–861

Lуpez F, Triantafyllou A, Snyderman CH et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck. 2017 May; 39(5):1033-1045.

Lee JT, Chen P, Safa A, Juillard G, Calcaterra TC. The role of radiation in the treatment of advanced juvenile angiofibroma. Laryngoscope 2002; 112:1213–1220.

Chakraborty S, Ghoshal S, Patil VM et al. Conformal radiotherapy in the treatment of advanced juvenile nasopharyngeal angiofibroma with intracranial extension: an institutional experience. Int J Radiat Oncol Biol Phys 2011; 80:1398–1404.

D. Radkowski, T. McGill, G.B. Healy, et al.Angiofibroma. Changes in staging and treatment Arch Otolaryngol Head Neck Surg, 122 (1996), pp. 122-129

Fields JN, Halverson KJ, Devineni VR, et al. Juvenile nasopharyngeal angiofibroma: Efficacy of radiation therapy. Radiology 1990; 176:263–265.

Reddy KA, Mendenhall WM, Amdur RJ, Stringer SP, Cassisi NJ. Longterm results of radiation therapy for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 2001; 22:172–175.

Cummings BJ, Blend R, Keane T, et al. Primary radiation therapy for juvenile nasopharyngeal angiofibroma. Laryngoscope 1984;94:1599–1605.

Amdur RJ, Yeung AR, Fitzgerald BM, Mancuso AA, Werning JW, Mendenhall WM. Radiotherapy for juvenile nasopharyngeal angiofibroma. Pract Radiat Oncol 2011; 1:271–278.

Spagnolo DV, Papadimitriou JM, Archer M. Postirradiation malignant fibrous histiocytoma arising in juvenile nasopharyngeal angiofibroma and producing alpha-1- antitrypsin. Histopathology 1984; 8:338–352.

Chen KT, Bauer FW. Sarcomatous transformation of nasopharyngeal angiofibroma. Cancer 1982;49:369–371.

Beriwal S, Eidelman A, Micaily B. Three-dimensional conformal radiotherapy for treatment of extensive juvenile angiofibroma: Report on two cases. ORL J Otorhinolaryngol Relat Spec 2003; 65:238–241.

Kuppersmith RB, Teh BS, Donovan DT, et al. The use of intensity modulated radiotherapy for the treatment of extensive and recurrent juvenile angiofibroma. Int J Pediatr Otorhinolaryngol 2000; 52:261 268.




DOI: http://dx.doi.org/10.14748/orl.v14i2.6771

Refbacks

Font Size


|