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. 2022 Jan 21;17(1):13.
doi: 10.1186/s13014-022-01980-0.

Irradiation-induced nasopharyngeal necrosis (INN) in newly diagnosed nasopharyngeal carcinoma treated by intensity-modulated radiation therapy: clinical characteristics and the influence of treatment strategies

Yi Xu  1 , Yang Liu  1 , Zekun Wang  1 , Jingbo Wang  1 , Jianghu Zhang  1 , Xuesong Chen  1 , Runye Wu  1 , Qingfeng Liu  1 , Yuan Qu  1 , Kai Wang  1 , Xiaodong Huang  1 , Jingwei Luo  1 , Li Gao  1 , Guozhen Xu  1 , Ye Zhang  2 , Junlin Yi  3
Affiliations

Irradiation-induced nasopharyngeal necrosis (INN) in newly diagnosed nasopharyngeal carcinoma treated by intensity-modulated radiation therapy: clinical characteristics and the influence of treatment strategies

Yi Xu et al. Radiat Oncol. .

Abstract

Purpose: To define the clinical characteristics of irradiation-induced nasopharyngeal necrosis (INN) after intensity-modulated radiotherapy (IMRT) and identify the influence of treatment strategies on INN in primary nasopharyngeal carcinoma (NPC) patients.

Patients and methods: From 2008 to 2019, NPC patients pathologically diagnosed with INN after primary IMRT were reviewed. Those patients were matched with propensity scores for patients without INN in our center. The impact of treatment strategies on INN occurrence was assessed using univariate and multivariate logistic regression analysis.

Results: The incidence rate of INN was 1.9% among the primary NPC population, and 53 patients with INN were enrolled. Headache and foul odor were the main symptoms, and 71.7% of cases had pseudomembrane during or at the end of radiotherapy. All patients were in early or middle stage INN, and no one presented with skull-based osteoradionecrosis. Then 212 non-INN patients were included based on propensity scores match. Overall survival (p = 0.248) and progression-free survival (p = 0.266) curves were similar between the INN and non-INN groups. Treatment strategies including combining chemotherapy or molecular targeted therapy with radiotherapy were not associated with INN occurrence, while boost dose (OR 7.360; 95% CI 2.301-23.547; p = 0.001) was a predictor factor for it. However, the optimal threshold for an accumulated dose to predict INN's occurrence was failed to determine.

Conclusion: In the IMRT era, the severity of INN in primary NPC patients is lessened. This study showed that treatment strategies contributed little to develop INN, while the accumulated dose of radiation may relate to its occurrence.

Keywords: Intensity-modulated radiation therapy; Irradiation-induced nasopharyngeal necrosis; Primary nasopharyngeal carcinoma.

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Conflict of interest statement

The authors have no conflict of interest. This study involving human participants was reviewed and approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences. Confirming that all methods were performed under the relevant guidelines and regulations in the methods section and the informed consent was obtained from all participants or their respective legally authorized persons.

The author(s) declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment
Fig. 2
Fig. 2
Kaplan–Meier curves of overall survival and progression-free survival of the INN group and non-INN group after propensity score matching
See this image and copyright information in PMC

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