The treatment of advanced juvenile nasopharyngeal angiofibroma?

American Journal of Otolaryngology, 2001

International journal of pediatric otorhinolaryngology, 1993

Juvenile nasopharyngeal angiofibroma is a benign, vascular tumor which typically presents in adolescent males. Although surgical resection is usually recommended for the management of this tumor, external beam radiation therapy has also been advocated in the literature. We report three cases of large juvenile nasopharyngeal angiofibromas with extensive intracranial extension primarily managed with external beam radiation therapy. Although there was not complete resolution of the tumors, there was significant alleviation of symptomatology with no serious side effects from the radiation therapy. Based on these cases, we feel that external beam radiation therapy in the management of extensive juvenile nasopharyngeal angiofibromas with intracranial extension is warranted in certain select cases.

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2008

Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive, vascular tumour of adolescent males. Extension to intracranial cavity is not uncommon and presents difficulties in management. Here we report a patient who had Radkowsky stage IIIB lesion, with blood supply from internal carotid artery. In view of anticipated problems with surgery, the patient was treated with 30 Gy in 15# external beam radiotherapy. On follow up, tumour was noted to disappear gradually overtime and at 3 years complete disappearance was noted with normal return of vision. Hence we are re-affirming the earlier studies than angiofibroma mass regresses gradually after completion of radiotherapy. Radiotherapy is a useful way of treating angiofibroma with significant intracranial extension.

Otolaryngology - Head and Neck Surgery, 2008

Archives of Pediatrics & Adolescent Medicine, 1981

Review of the literature was performed to define the optimal treatment of patients with juvenile nasopharyngeal angiofibroma (JNA). The prognosis for this disease is extremely good if diagnosed well in time and if the tumor has not extended intracranially. Preoperative selective arterial embolization has decreased intraoperative blood loss and facilitated resection of larger tumors. Transnasal endoscopic resection preserves both the anatomy and physiology of the nose, requires less rehabilitation days after surgery, and is highly successful for selected patients. Radiation therapy is generally reserved for larger and/or unressectable tumors but has severe complications. Radiosurgery has several advantages over surgery or classic radiation therapy. However, further experiences and studies are required to confirm the usefulness of radiosurgery on JNA.

Otolaryngology - Head and Neck Surgery, 2000

Although surgery is regarded as the mainstay of treatment for juvenile nasopharyngeal angiofibromas (JNAs), ancillary treatment modalities such as radiotherapy and on rare occasions chemotherapy are still recommended by many for intracranial extension with apparent radiologic involvement of the cavernous sinus and internal carotid artery.

European Archives of Oto-Rhino-Laryngology, 2001

The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of JNA were treated at our institution from 1975 to 1999. Thirty-three male patients aged between 8 and 25 years (mean 15.3) were included. Twenty-nine patients underwent primary surgical treatment at our institution and four were treated for recurrence following primary surgery elsewhere. Tumors were staged according to Fisch's staging. Preoperative embolization was performed in 22 cases. Surgical techniques consisted of the transantral approach, lateral rhinotomy approach, transmaxillary via midfacial degloving approach, and the subtemporal preauricular infratemporal fossa approach. Tumors were classified stage I in seven cases, stage II in 11, stage III in 13 and stage IV in two. The mean delay between the initial symptom and surgery was 14 months overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12 for stage IV. The transantral approach was used in 11 patients, lateral rhinotomy approach in 11 cases, transmaxillary via midfacial degloving approach in three patients, and pre-auricular infra-temporal approach in eight patients. Mean follow-up after surgery was 56 months. Six patients had recurrent tumors. Surgery is the gold standard for treatment of JNA. Modern imaging techniques allow accurate diagnosis and staging of JNA. Our experience and a review of the literature shows that the surgical approach should be selected according to tumor stage.

INDIAN JOURNAL OF APPLIED RESEARCH, 2024

Juvenile nasopharyngeal angiofibroma is the common tumor of nasopharynx.The prognosis for this disease is extremely good if diagnosed well in time and if the tumor has not extended intracranially. Preoperative selective arterial embolization has decreased intraoperative blood loss and facilitated resection of larger tumors. Transnasal endoscopic resection preserves both the anatomy and physiology of the nose, requires less rehabilitation days after surgery,and is highly successful for selected patients. Radiation therapy is generally reserved for larger and/or unresectable tumors but has severe complications..Radio surgery has several advantages over surgery or classic radiation therapy. However, further experiences and studies are required to confirm the usefulness of radiosurgery on JNA

European Archives of Oto-Rhino-Laryngology, 2011

The management of juvenile nasopharyngeal angioWbroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.

International Journal of Pediatric Otorhinolaryngology, 2000

These case series are presented to describe the application and advantages of intensity modulated radiotherapy (IMRT) for the treatment of extensive and/or recurrent juvenile angiofibroma. Two patients were diagnosed with recurrence at 11 and 13 months postoperatively, and one was surgically unresectable. The affected areas included the base of skull, cavernous sinus, pterygopalatine fossa, infratemporal fossa, posterior orbit and nasopharynx. Highly conformal IMRT was delivered with limited radiation doses to the optic nerves, optic chiasm, brainstem, brain, spinal cord, lens, retina, mandible, and parotid. The total dose delivered to the tumor varied from 3400 to 4500 cGy. The tumor shrunk radiographically in all three cases and there was no endoscopic evidence of disease in two cases at 15 months and 40 months. There was no acute toxicity. Late toxicity was limited to one episode of epistaxis and persistent rhinitis in one patient. In conclusion, IMRT provides several advantages over conventional radiotherapy in the treatment of recurrent juvenile angiofibroma.