Nasopharyngeal Granulomas after Radiotherapy for Nasopharyngeal Carcinoma: Developing a Management Strategy

Objective: Nasopharyngeal granulomas are uncommon masses that occur after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Their persistent bleeding can be a management challenge, and an underlying recurrence or sarcoma may pose a diagnostic dilemma. The aim of this study was to develop a management strategy for this rare but problematic condition.

Design: The clinical records of patients who had previously received RT for NPC and who were subsequently managed for a nasopharyngeal granuloma between 2006 and 2011 were reviewed.

Patients/Materials and Methods: Eight male and five female patients with a mean age of 56.2 years (range, 44.4–70.8 years) were studied. The mean follow-up after debulking surgery was 2 years (range, 0.2–5.4 years).

Results: Six patients had received RT alone and seven underwent a combination of chemotherapy and RT for NPC. The mean time for presentation of the granuloma after RT was 11.6 years (range, 1.3 to 23.7 years). Eleven patients underwent debulking surgery under general anesthesia and two under topical or local anesthesia. Four required a tracheostomy at surgery for subsequent airway protection. In four patients, the granuloma recurred, requiring multiple surgeries. Eight patients had evidence of osteoradionecrosis on imaging. Four patients received local steroid injection and three underwent hyperbaric oxygen therapy. At last follow-up, nine patients were free of granulomas.

Conclusions: Maximum debulking of a nasopharyngeal granuloma, usually under general anesthesia and sometimes with a temporary tracheostomy, resulted in a 70% cure of the condition in this series. Augmentation by local steroid injections and hyperbaric oxygen therapy are possibly useful.