Chronic rhinosinusitis in nasopharyngeal carcinoma patients post- IMRT: a meta-analysis.

Background: Intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) can cause chronic rhinosinusitis (CRS), an underexplored side effect. This review aimed to determine the incidence and severity of CRS in NPC patients post-IMRT.

Methods: Electronic databases (PubMed, CINAHL, Embase, Cochrane Library, Web of Science) were searched for studies published from 2000 onwards. Eligible studies assessed CRS in NPC patients post-IMRT, using validated methods per EPOS 2020 (Lund-Mackay (LM) CT scoring, Lund-Kennedy (LK) endoscopic scoring, SNOT questionnaire). Meta-analysis was conducted using SPSS and R to quantify pooled CRS incidence and severity.

Results: Nine studies (n=1,478) were included, revealing distinct patterns in CRS development and severity. Patients without prior sinusitis showed significantly increased likelihood of developing CRS post-IMRT, while those with prior sinusitis had reduced odds due to a ceiling effect, as CRS was already present in 100% of these patients before IMRT. Both groups showed significant increases in CRS severity pre- and post-IMRT, with the LK and LM scoring methods showing the most substantial changes.

Conclusions: This review underscores the significant increases in both the incidence and severity of CRS in NPC patients post- IMRT. Clinicians should recognise the risk of CRS post-IMRT and recommend options to reduce the likelihood of CRS development.