Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

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

doi:10.1002/lio2.345

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Laryngoscope Investig Otolaryngol. 2020 Jan 22;5(1):19-23. doi: 10.1002/lio2.345. eCollection 2020 Feb.

Authors

Affiliations

¹ Department of Otorhinolaryngology Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière Paris France.
² Department of Neuroradiology Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière Paris France.
³ Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis Paris France.
⁴ Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis Paris France.
⁵ Université de Paris Paris France.
⁶ Department of Medical Oncology Hôpital Bégin Saint-Mandé France.
⁷ NeuroDiderot, Inserm Université de Paris Paris France.

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.

Keywords: Clivus; chordoma; endoscopic surgery; nasopharyngeal carcinoma; olfactory neuroblastoma; osteoradionecrosis; pentoxifylline‐tocopherol‐clodronate; radiotherapy; skull base; sphenoid.