“Ah, There’s A Bit Left” - How to Manage Residual and Recurrent Disease in Advanced Juvenile Nasopharyngeal Angiofibroma
Dr Shivani Angelique Kumar, Otolaryngology Head and Neck Surgery Registrar, NSW Health, Australia
Authors List
Kumar, S. A., Macquarie University, Sydney, Australia; Campbell, R. G., Macquarie University, Sydney, Australia
Background: Advanced Juvenile nasopharyngeal angiofibroma’s (JNAs) are lesions that involve the skull base and extend intracranially, which often pose a surgical challenge (1, 2). Many controversies exist regarding management of residual or recurrent advanced disease.
Aims: To characterise the natural history of recurrent and residual advanced JNAs to answer the question “Do we need to actively treat recurrent or residual disease?”
Methods: A PRISMA systematic review was undertaken from inception to February 2025 of PubMed, Embase, Scopus and Web of Science databases. Inclusion criteria included original peer-reviewed papers with data relating to the management of residual, recurrent or unresectable advanced JNAs.
Results: Eighty-three studies were screened and 128 male patients with recurrent or residual advanced JNAs were extracted. One patient, a 10-year-old, suffered a fatal complication (epistaxis) from residual disease one month after initial treatment. Two patients were lost to follow-up. The remaining 125 patients were followed-up and found to either have stable asymptomatic disease (29%), decreasing size of tumour (26%) or complete involution of disease without further intervention (41%). Only 2% of patients were noted to have an increase in the size of the residual or recurrent disease.
Conclusion: Residual or recurrent advanced JNA’s have a natural history of either completely involuting, decreasing in size or remaining stable over long periods of time after initial management. Therefore, clinicians may consider closely monitoring these patients with regular follow-up and imaging, especially if the patient is asymptomatic, as opposed to active management.
References
1. Álvarez FL, Suárez V, Suárez C, Llorente JL. Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas. Head and Neck. 2013;35(2):209-13. 2. Bales C, M. K, Loevner LA, Al-Rawi M, Weinstein G, Hurst R, et al. Craniofacial resection of advanced juvenile nasopharyngeal angiofibroma. Archives of otolaryngology--head & neck surgery. 2002;128(9):1071–8.
Kumar, S. A., Macquarie University, Sydney, Australia; Campbell, R. G., Macquarie University, Sydney, Australia
Background: Advanced Juvenile nasopharyngeal angiofibroma’s (JNAs) are lesions that involve the skull base and extend intracranially, which often pose a surgical challenge (1, 2). Many controversies exist regarding management of residual or recurrent advanced disease.
Aims: To characterise the natural history of recurrent and residual advanced JNAs to answer the question “Do we need to actively treat recurrent or residual disease?”
Methods: A PRISMA systematic review was undertaken from inception to February 2025 of PubMed, Embase, Scopus and Web of Science databases. Inclusion criteria included original peer-reviewed papers with data relating to the management of residual, recurrent or unresectable advanced JNAs.
Results: Eighty-three studies were screened and 128 male patients with recurrent or residual advanced JNAs were extracted. One patient, a 10-year-old, suffered a fatal complication (epistaxis) from residual disease one month after initial treatment. Two patients were lost to follow-up. The remaining 125 patients were followed-up and found to either have stable asymptomatic disease (29%), decreasing size of tumour (26%) or complete involution of disease without further intervention (41%). Only 2% of patients were noted to have an increase in the size of the residual or recurrent disease.
Conclusion: Residual or recurrent advanced JNA’s have a natural history of either completely involuting, decreasing in size or remaining stable over long periods of time after initial management. Therefore, clinicians may consider closely monitoring these patients with regular follow-up and imaging, especially if the patient is asymptomatic, as opposed to active management.
References
1. Álvarez FL, Suárez V, Suárez C, Llorente JL. Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas. Head and Neck. 2013;35(2):209-13. 2. Bales C, M. K, Loevner LA, Al-Rawi M, Weinstein G, Hurst R, et al. Craniofacial resection of advanced juvenile nasopharyngeal angiofibroma. Archives of otolaryngology--head & neck surgery. 2002;128(9):1071–8.
