Journal of stomatology, oral and maxillofacial surgery · 2025
Nasal irrigation reduces radiation-induced rhinosinusitis in nasopharyngeal carcinoma treated with volumetric modulated arc therapy.
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Li Jiarong, Ji Yanchen, Yang Zhining, Lin Baihan, Zhang Ying, Xie Renxian
Аннотация
BACKGROUND: Nasopharyngeal carcinoma (NPC), prevalent in Southeast Asia and Southern China, is commonly treated with radiotherapy (RT). Volumetric modulated arc therapy (VMAT) improves tumor control but radiation-induced rhinosinusitis (RIRS) remains a major complication. Nasal irrigation shows potential in mitigating mucosal damage, yet evidence in VMAT-treated NPC patients is limited. This study evaluates Nasal irrigation's efficacy in reducing RIRS incidence in this population.
METHODS: A retrospective cohort of 195 NPC patients treated with VMAT (2018-2021) was analyzed. Patients were divided into Nasal irrigation (n = 84) and non-Nasal irrigation (n = 111) groups. Baseline characteristics and dosimetric parameters (V20-V70, Dmean, Dmax) of the maxillary sinus were compared. Kaplan-Meier analysis and Cox regression models assessed Nasal irrigation's impact on RIRS risk, with subgroup analyses stratified by sex, TNM stage, and treatment regimen.
RESULTS: Kaplan-Meier analysis showed that the probability of developing RIRS was significantly higher in the group that did not undergo nasal irrigation compared with the NI group (p < 0.001). Multivariate analysis confirmed NI reduced RIRS risk (adjusted HR=0.26, p < 0.001), while allergic rhinitis increased risk (adjusted HR=6.56, p = 0.009). For maxillary sinusitis, NI remained protective (HR=0.29, p < 0.001), and higher V70 dose (≥70 Gy) correlated with elevated risk (HR=1.10, p = 0.007). Subgroup analyses demonstrated consistent benefits across sex, T/N stage, and treatment groups (all interaction p > 0.05).
CONCLUSION: NI reduces radiation-induced rhinosinusitis risk in VMAT-treated NPC patients, independent of baseline characteristics. Allergic rhinitis and high V70 doses independently worsen outcomes. These findings support NI as a simple, effective adjunct to improve post-radiotherapy quality of life.
METHODS: A retrospective cohort of 195 NPC patients treated with VMAT (2018-2021) was analyzed. Patients were divided into Nasal irrigation (n = 84) and non-Nasal irrigation (n = 111) groups. Baseline characteristics and dosimetric parameters (V20-V70, Dmean, Dmax) of the maxillary sinus were compared. Kaplan-Meier analysis and Cox regression models assessed Nasal irrigation's impact on RIRS risk, with subgroup analyses stratified by sex, TNM stage, and treatment regimen.
RESULTS: Kaplan-Meier analysis showed that the probability of developing RIRS was significantly higher in the group that did not undergo nasal irrigation compared with the NI group (p < 0.001). Multivariate analysis confirmed NI reduced RIRS risk (adjusted HR=0.26, p < 0.001), while allergic rhinitis increased risk (adjusted HR=6.56, p = 0.009). For maxillary sinusitis, NI remained protective (HR=0.29, p < 0.001), and higher V70 dose (≥70 Gy) correlated with elevated risk (HR=1.10, p = 0.007). Subgroup analyses demonstrated consistent benefits across sex, T/N stage, and treatment groups (all interaction p > 0.05).
CONCLUSION: NI reduces radiation-induced rhinosinusitis risk in VMAT-treated NPC patients, independent of baseline characteristics. Allergic rhinitis and high V70 doses independently worsen outcomes. These findings support NI as a simple, effective adjunct to improve post-radiotherapy quality of life.