Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma.

BACKGROUND Radiation-induced nasopharyngeal necrosis is a consequential late effect in the patients with nasopharyngeal carcinoma (NPC). Patients with NPC who have been treated with high-dose radiotherapy are at risk of developing postradiation nasopharyngeal necrosis (PRNN). However, the analysis of PRNN with a significant cohort of patients has not been reported in English-language literature. In this study, we aimed to evaluate PRNN in 28 patients with NPC. METHODS From June 2006 to December 2007, 28 patients were diagnosed with PRNN with pathologic evidence. Surgical procedure of endoscopy-guided debridement and systemic anti-inflammatory treatments were conducted for the patients. Their clinical features, treatment procedures, and outcomes were analyzed retrospectively. RESULTS Clinical symptoms such as foul odor and headache were alleviated in all, 8 patients were cured of their PRNN, 9 patients with exposed internal carotid artery died of sudden nasopharyngeal massive bleeding, and 3 patients died of exhaustion (cachexia). CONCLUSION PRNN is an important consequential late effect of radiotherapy in the patients with NPC. Internal carotid artery erosion is a severe situation and acts as an independent prognostic factor for the patients. Diagnosis of PRNN could be made after ruling out the persistent-recurrent NPC proven by pathologic examination. Surgery is effective for improving the quality of life and for curing PRNN.