Incidence and Risks of Chronic Rhinosinusitis in Head and Neck Cancer: A Meta-Analysis.
John Dewey, Heli Majeethia, Kushal Modi et al.
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In 30 seconds
This systematic review and meta-analysis assessed chronic rhinosinusitis (CRS) after treatment for head and neck cancer (HNC) in adults. Seventeen studies, including 3685 patients, were pooled, although diagnostic methods varied substantially. The overall pooled CRS incidence was 0.37 (95% CI, 0.27-0.47). Incidence was higher in nasopharyngeal cancer (NPC) than in other HNC (0.45 vs. 0.18, p < 0.001). Radiation therapy was associated with increased CRS risk, particularly among patients with NPC; qualitative findings also implicated advanced disease stage and concurrent chemotherapy.
Key findings
- Pooled CRS incidence across HNC patients was 0.37 (95% CI, 0.27-0.47).
- CRS incidence was higher with NPC than other HNC: 0.45 vs. 0.18, p < 0.001.
- Radiation therapy was associated with higher CRS risk (log OR = 1.46, 95% CI of 0.76, 2.16), with a stronger association in NPC (log OR of 1.82 vs. log OR of 0.52, p = 0.01).
- The maxillary sinuses were most commonly involved (incidence 0.60), followed by the ethmoid sinuses (0.45).
Why it matters
CRS is a relevant post-treatment outcome in HNC, and the pooled findings suggest that risk differs by cancer site and treatment exposure. Awareness of these associations can inform clinical attention to sinonasal symptoms during and after cancer care, while the substantial variation in diagnostic methods cautions against treating the pooled incidence as a uniform estimate.
What to keep in mind
The included studies differed substantially in how CRS was diagnosed, and the pooled evidence combines studies with differing designs and populations.