Intensity modulated radiotherapy (IMRT) in patients with carcinomas of the paranasal sinuses: clinical benefit for complex shaped target volumes.
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INTRODUCTION: The aim of the study was to evaluate the clinical outcome of intensity modulated radiotherapy (IMRT) in 46 patients with paranasal sinus tumors with special respect to treatment-related toxicity. PATIENTS AND METHODS: We treated 46 patients with histologically proven tumors of the paranasal sinuses with IMRT. Histological classification included squamous cell carcinoma in 6, adenocarcinoma in 8, adenoidcystic carcinoma in 20 and melanoma in 8 patients, respectively. Six patients had been treated with RT during initial therapy after primary diagnosis, and IMRT was performed for the treatment of tumor progression as re-irradiation. RESULTS: Overall survival rates were 96% at 1 year, 90% at 3 years. Calculated from the initiation of IMRT as primary radiotherapy, survival rates at 1 and 3 years were 95% and 80%. In six patients IMRT was performed as re-irradiation, and survival rate calculated from re-irradiation was 63% at 1 year. Local control rates were 85% at 1, 81% at 2 and 49% at 3 years after primary RT and 50% at 1 year after re-irradiation. Distant metastases-free survival in patients treated with IMRT as primary RT was 83% after 1 and 64% after 3 years. For patients treated as primary irradiation with IMRT, the distant control rate was 83% at 1 year and 0% at 2 years. No severe radiation-induced side-effects could be observed. CONCLUSION: IMRT for tumors of the paranasal sinuses is associated with very good tumor control rates. Treatment-related acute and long-term toxicity can be minimized as compared to historical results with conventional RT. (+info)
Nucleotide sequencing for diagnosis of sinusal infection by Schizophyllum commune, an uncommon pathogenic fungus.
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Schizophyllum commune, a basidiomycete fungus, is a rare cause of mycotic disease. We report here a case of sinusitis in a 35-year-old woman that underscores the value of molecular biology for the diagnosis of this fungal infection. (+info)
Invasive squamous cell carcinoma of the eyelids and periorbital region.
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AIM: To review the clinical and histopathological features, treatment and outcomes of squamous cell carcinoma of the eyelids. METHODS: 76 patients with eyelid squamous cell carcinoma treated in an oncology referral hospital between 1997 and 2006 were reviewed retrospectively. Age, sex, risk factors, duration of symptoms, size and location of lesion, previous recurrences, presence of perineural invasion (PNI) and orbital invasion, histological subtype, inflammatory response of peritumoral tissue were recorded and analysed. RESULTS: Mean (SD) lesion size was 2.4 (0.36) mm. 27 (35.5%) cases were previously recurrent. The most common histological subtype was well differentiated (59.2%). The rates of PNI and orbital invasion were 23.8% and 43.4%, respectively. 63 patients underwent surgery, whereas others were treated with external radiotherapy or chemotherapy. Recurrence or presence of residual tumour rate was 22.4%, most of them had orbital invasion. Regional lymph node metastasis was detected in 5 (6.6%) cases. CONCLUSIONS: Advanced deep local invasion was not rare in this study, as a result of treatment delay and previous inadequate treatments. Adverse prognostic factors associated with secondary orbital invasion are previous recurrences, longer duration of lesion, larger lesion size, and presence of PNI. Well-differentiated subtype and strong inflammatory response are good prognostic factors. (+info)
Computed tomography findings in chronic rhinosinusitis patients with and without allergy.
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The purpose of this study was to compare the paranasal sinus mucosal thickenings, bony changes consistent with chronic sinusitis, and bony anatomic variations detected by computed tomography (CT) in chronic rhinosinusitis patients with and without allergy. Three hundred and thirty-nine patients with chronic rhinosinusitis were analyzed for their allergic status by performing skin prick test. Two hundred and thirteen patients (62.8%) had at least one positive skin prick test (allergic patients, male/female: 85/128, mean age: 29.1 +/- 1.2). One hundred and twenty-six patients (37.2%) were included in the non-allergic group (male/female: 53/73, mean age: 31 +/- 2.2). Maxillary mucosal thickening and frontal hypoplasy were significantly more common in allergic chronic rhinosinusitis patients. Moreover, pneumatized uncinate process is apparently more common in the allergic group than non-allergic group, and statistical analysis revealed marginal significance (p = 0.0535). In conclusion CT findings of allergic chronic rhinosinusitis patients are comparable to the CT findings of chronic rhinosinusitis patients without allergy. However, presence of maxillary mucosal thickening, frontal hypoplasia or pneumatized uncinate process in the CT scan of a patient with chronic rhinosinusitis could be of clinical significance, and might guide the otolaryngologist for the evaluation of the presence of allergy. (+info)
Focal hyperostosis on CT of sinonasal inverted papilloma as a predictor of tumor origin.
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BACKGROUND AND PURPOSE: To evaluate the CT characteristics of focal hyperostosis in patients with sinonasal inverted papilloma and to correlate these characteristics with the detection of the origins of tumors. MATERIALS AND METHODS: Paranasal sinus and nasal cavity CT images of 76 patients were reviewed retrospectively to detect areas within which there was focal hyperostosis. We correlated the sites on the CT scans within which there was focal hyperostosis with the origin of the tumors described in the corresponding patient's medical records. We also evaluated the CT features of focal hyperostosis according to the origin of tumors. RESULT: Surgical evaluation of 55 lesions with focal hyperostosis in CT images revealed that 49 of these lesions coincided with the actual origin of tumor. The CT-based determination of the locations of the areas of focal hyperostosis corresponded to the actual tumor origin in 89.1% of cases. Especially in cases with focal hyperostosis within the frontal, maxillary, sphenoid, and posterior ethmoid sinuses, areas of focal hyperostosis corresponded to the origin of tumor without exception. In the evaluation of the CT features of focal hyperostosis, 2 patterns of localized bone thickening were noted. Plaquelike bone thickening was seen mainly when focal hyperostosis involved the lateral wall of the nasal cavity. On the other hand, cone-shaped bone thickening was seen only in the walls of the paranasal sinuses or the bony septum. CONCLUSIONS: A high correlation between the origin of the inverted papilloma and focal hyperostosis on CT might facilitate preoperative prediction of tumor origin by radiologists and rhinologists. (+info)
Radiological evidence of sinus infection in patients with multiple sclerosis.
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The prevalence of radiological criteria of chronic sinus infection was compared in 42 cases of clinically definite or laboratory supported definite multiple sclerosis and 84 controls. No increase in relative risk of multiple sclerosis associated with the presence of chronic sinus infection was observed (odds ratio 1.2, 95% CI 0.5 to 3.1). The maxillary sinus was infected more often than the other paranasal sinuses but there was no difference in the distribution of infection within the sinuses between cases and controls. These results do not confirm an earlier report of an association between chronic sinus infection and multiple sclerosis. (+info)
AIM: The aim of the paper was to perform a 64-slice CT evaluation of the main anatomic variants of paranasal sinuses. METHODS: From April 2005 to January 2006, 100 patients were chosen among all those that had undergone a paranasal sinuses CT examination. They were 45 women and 55 men, all aged between 18 and 70 years, mean age 46 years; they were all caucasian. This research has been conducted using a 64-slice Siemens Somatom Volume-Zoom multidetector Spiral CT. Para-nasal sinuses CT examination has been performed through a thin axial acquisition; the patient was lying on his back and the images were processed with multiplanar reconstruction (MPR). The anatomic variants considered in this study are: concha bullosa, Haller cells, uncinate process abnormalities, agger nasi cells, ethmoidal bulla, Onodi cell, middle turbinate curvature abnormalities. RESULTS: In this research it has been noticed that 29% of patients are affected by concha bullosa, 5% by Haller cells and again 5% by uncinate process abnormalities; 52% are affected by agger nasi cells, 15% by ethmoidal bulla, 9% by Onodi cell and 11% by middle turbinate curvature abnormalities. CONCLUSION: By using a 64-slice CT you can get a better quality of images in terms of spatial and temporal resolution. Osteomeatal complex structures are often featured by many anatomic variants. The most of the time, percentages are the same as recent researches have shown. (+info)
Relatively light general anesthesia is more effective than fluid expansion in reducing the severity of epinephrine-induced hypotension during functional endoscopic sinus surgery.
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BACKGROUND: Epinephrine infiltration of the nasal mucosa causes hypotension during functional endoscopic sinus surgery (FESS) under general anesthesia. A prospective randomized-controlled study was designed to determine whether relatively light general anesthesia is superior to fluid expansion in reducing epinephrine-induced hypotension during FESS. METHODS: Ninety patients undergoing elective FESS under general anesthesia were randomly assigned to three groups with 30 patients in each. Each patient received local infiltration with adrenaline-containing (5 microg/ml) lidocaine (1%, 4 ml) under different conditions. For Group I, anesthesia was maintained with propofol 2 microg/ml and rimifentanil 2 ng/ml by TCI. Group II (control group) and Group III received propofol 4 microg/ml and rimifentanil 4 ng/ml, respectively. In Groups I and II, fluid expansion was performed with hetastarch 5 ml/kg within 20 minutes; hetastarch 10 ml/kg was used in Group III. Mean arterial pressure (MAP) and heart rate (HR) were recorded at 30-second-intervals for 5 minutes after the beginning of local infiltration. Simultaneously, the lowest and the highest MAP were recorded to calculate the mean maximum increase or decrease percent in MAP for all patients in each group. Data analysis was performed by chi(2) test, one-way analysis of variance, or one-way analysis of covariance. RESULTS: Hemodynamic changes, particularly a decrease in MAP accompanied by an increase in HR at 1.5 minutes (P < 0.05), were observed in all groups. The mean maximum decrease in MAP below baseline was 14% in Group I, 24% in Group III and 26% in Group II. There were statistically significant differences between Group I and Groups II and III (P < 0.05). The mean maximum increase in MAP above baseline was 9% in Group I, 6% in Group III and 2% in Group II. CONCLUSION: Relatively light general anesthesia can reduce the severity of epinephrine-induced hypotension more effectively than fluid expansion during FESS under general anesthesia. (+info)