Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results
Abstract Objective Osteoradionecrosis (ORN) of the sphenoid is a rare but potentially lethal complication that can occur after irradiation of nasopharyngeal and clival malignancies. The objective of this study was to describe a multimodal treatment strategy tailored to the clinical signs and to the...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-02-01
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| Series: | Laryngoscope Investigative Otolaryngology |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/lio2.345 |
| _version_ | 1828930280354742272 |
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| author | Hannah Daoudi Marc A. Labeyrie Sophie Guillerm Sylvie Delanian Jean‐Pierre Guichard Clément Jourdaine Sandrine Faivre Helene Gauthier François‐Régis Ferrand Benjamin Verillaud Philippe Herman |
| author_facet | Hannah Daoudi Marc A. Labeyrie Sophie Guillerm Sylvie Delanian Jean‐Pierre Guichard Clément Jourdaine Sandrine Faivre Helene Gauthier François‐Régis Ferrand Benjamin Verillaud Philippe Herman |
| author_sort | Hannah Daoudi |
| collection | DOAJ |
| description | Abstract Objective Osteoradionecrosis (ORN) of the sphenoid is a rare but potentially lethal complication that can occur after irradiation of nasopharyngeal and clival malignancies. The objective of this study was to describe a multimodal treatment strategy tailored to the clinical signs and to the radiological extent of the disease, and to report on its preliminary results. Methods Retrospective monocentric study at a tertiary skull base center. Patients treated for a sphenoid ORN from January 2014 to August 2018 were identified and charts were retrospectively reviewed for demographics, histologic tumor type, previous treatments of the tumor, clinical signs at presentation, radiological data, treatment, and outcomes. Sphenoid ORN was treated by a combination of medical therapy, endovascular treatment, and/or surgery. The use of each of these therapeutic modalities was based on the extent of ORN and on the presenting signs. Results Seven patients were included: four patients underwent endovascular treatment with occlusion of the internal carotid artery, five patients underwent surgical debridement, and covering of the exposed bone by a local flap, seven patients received antibiotics (in combination with pentoxyphilline, tocopherol, and clodronate in one case). Three patients died after progression of the ORN. The global survival rate was 57% (4/7) with a mean follow‐up of 24 months. In one case, ORN was treated successfully by medical treatment only, with a combination of antibiotics, pentoxyphilline, tocopherol, and clodronate. Conclusion This retrospective study describes the results of a management strategy adapted to the extent of the disease in sphenoid ORN and based on medical therapy only, or on a combination of medical therapy, interventional radiology, and/or surgery. Level of evidence 4 |
| first_indexed | 2024-12-14T00:30:29Z |
| format | Article |
| id | doaj.art-45a037aae00349dbac997a8fbdbe8ee3 |
| institution | Directory Open Access Journal |
| issn | 2378-8038 |
| language | English |
| last_indexed | 2024-12-14T00:30:29Z |
| publishDate | 2020-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Laryngoscope Investigative Otolaryngology |
| spelling | doaj.art-45a037aae00349dbac997a8fbdbe8ee32022-12-21T23:24:52ZengWileyLaryngoscope Investigative Otolaryngology2378-80382020-02-0151192310.1002/lio2.345Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary resultsHannah Daoudi0Marc A. Labeyrie1Sophie Guillerm2Sylvie Delanian3Jean‐Pierre Guichard4Clément Jourdaine5Sandrine Faivre6Helene Gauthier7François‐Régis Ferrand8Benjamin Verillaud9Philippe Herman10Department of Otorhinolaryngology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceDepartment of Neuroradiology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceDepartment of Radiotherapy Assistance Publique – Hôpitaux de Paris, Hôpital Saint‐Louis Paris FranceDepartment of Radiotherapy Assistance Publique – Hôpitaux de Paris, Hôpital Saint‐Louis Paris FranceDepartment of Neuroradiology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceDepartment of Otorhinolaryngology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceDepartment of Medical Oncology Assistance Publique – Hôpitaux de Paris, Hôpital Saint Louis Paris FranceDepartment of Medical Oncology Assistance Publique – Hôpitaux de Paris, Hôpital Saint Louis Paris FranceDepartment of Medical Oncology Hôpital Bégin Saint‐Mandé FranceDepartment of Otorhinolaryngology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceDepartment of Otorhinolaryngology Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière Paris FranceAbstract Objective Osteoradionecrosis (ORN) of the sphenoid is a rare but potentially lethal complication that can occur after irradiation of nasopharyngeal and clival malignancies. The objective of this study was to describe a multimodal treatment strategy tailored to the clinical signs and to the radiological extent of the disease, and to report on its preliminary results. Methods Retrospective monocentric study at a tertiary skull base center. Patients treated for a sphenoid ORN from January 2014 to August 2018 were identified and charts were retrospectively reviewed for demographics, histologic tumor type, previous treatments of the tumor, clinical signs at presentation, radiological data, treatment, and outcomes. Sphenoid ORN was treated by a combination of medical therapy, endovascular treatment, and/or surgery. The use of each of these therapeutic modalities was based on the extent of ORN and on the presenting signs. Results Seven patients were included: four patients underwent endovascular treatment with occlusion of the internal carotid artery, five patients underwent surgical debridement, and covering of the exposed bone by a local flap, seven patients received antibiotics (in combination with pentoxyphilline, tocopherol, and clodronate in one case). Three patients died after progression of the ORN. The global survival rate was 57% (4/7) with a mean follow‐up of 24 months. In one case, ORN was treated successfully by medical treatment only, with a combination of antibiotics, pentoxyphilline, tocopherol, and clodronate. Conclusion This retrospective study describes the results of a management strategy adapted to the extent of the disease in sphenoid ORN and based on medical therapy only, or on a combination of medical therapy, interventional radiology, and/or surgery. Level of evidence 4https://doi.org/10.1002/lio2.345chordomaClivusendoscopic surgerynasopharyngeal carcinomaolfactory neuroblastomaosteoradionecrosis |
| spellingShingle | Hannah Daoudi Marc A. Labeyrie Sophie Guillerm Sylvie Delanian Jean‐Pierre Guichard Clément Jourdaine Sandrine Faivre Helene Gauthier François‐Régis Ferrand Benjamin Verillaud Philippe Herman Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results Laryngoscope Investigative Otolaryngology chordoma Clivus endoscopic surgery nasopharyngeal carcinoma olfactory neuroblastoma osteoradionecrosis |
| title | Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results |
| title_full | Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results |
| title_fullStr | Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results |
| title_full_unstemmed | Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results |
| title_short | Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results |
| title_sort | multimodal strategy for the management of sphenoid osteoradionecrosis preliminary results |
| topic | chordoma Clivus endoscopic surgery nasopharyngeal carcinoma olfactory neuroblastoma osteoradionecrosis |
| url | https://doi.org/10.1002/lio2.345 |
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