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Dacryocystorhinostomy may improve nasolacrimal duct obstruction after radiation therapy for head, neck cancer
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Dacryocystorhinostomy proved largely effective in alleviating the symptoms of nasolacrimal duct obstruction in patients treated with high-dose radiation therapy for head and neck cancer, particularly when delayed until at least 12 months after the completion of radiation therapy, a study found.
“Scarring and secondary nasolacrimal duct obstruction is a well-known complication of treatment with external beam radiation therapy,” the study authors said. “In addition, some chemotherapeutic agents, such as taxanes, are known to cause canalicular and nasolacrimal duct stenosis. Surgical intervention in the form of dacryocystorhinostomy (DCR) or conjunctival DCR may be required to alleviate the symptoms of cancer treatment-induced nasolacrimal duct obstruction in patients with head and neck cancer.”
The retrospective review analyzed the clinical records of 43 consecutive patients with primary head and neck cancer who underwent DCR after receiving high-dose external beam radiation therapy in combination with ablation and/or chemotherapy. Median patient age was 56 years.
The median interval between radiation therapy and DCR was 12 months.
Twenty patients had DCR less than 12 months after radiation therapy; seven of these patients (35%) had recurrent symptoms. Twenty-three patients underwent DCR at least 12 months after radiation treatment; five of these patients (21%) had recurrent symptoms.
Of 43 eyes of 37 patients who underwent DCR with silicone tube placement, eight eyes of 16 patients who underwent DCR less than 12 months after radiation therapy, and four eyes 21 patients who underwent DCR at least 12 months after radiation therapy, had recurrent symptoms. The between-group difference was not statistically significant.
“While this difference did not reach statistical significance, there was a trend toward better outcomes when surgery was delayed until at least 12 months after completion of radiation therapy,” the authors said.
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