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Article Open Access

Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study

  • Authors:
    • Rui-Ling Xie
    • Si-Yuan Chen
    • Zheng-Kai Feng
    • Shao-Yan Feng
    • Peng Hua
    • Wen-Bin Wu
    • Xiao-Tong Duan
    • Chong-Yang Duan
    • Chao Lin
    • Bo Lv
    • Jin-Hui Wu
    • Rui You
    • Wei-Hua Jia
    • Ming-Yuan Chen
    • You-Ping Liu
  • View Affiliations / Copyright

    Affiliations: Department of Nasopharyngeal Carcinoma, Sun Yat‑sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China, Nasopharyngeal Carcinoma Center, The Fifth Affiliated Hospital of Sun Yat‑sen University, Zhuhai, Guangdong 519000, P.R. China, Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of People's Liberation Army, Guangzhou, Guangdong 510010, P.R. China, Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China, Department of Radiation Oncology, FuJian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat‑sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
    Copyright: © Xie et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 406
    |
    Published online on: June 23, 2025
       https://doi.org/10.3892/ol.2025.15152
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Abstract

The aim of the present study was to investigate the incidence and risk factors for persistent severe mastoid mucosa disease (MMD), which has not been previously evaluated among patients with nasopharyngeal carcinoma (NPC) after radiotherapy (RT), to the best of our knowledge. Patients with NPC were identified from a prospective observational cohort between January 2010 and December 2015. Persistent Grade 2 MMD (PG2MMD) was defined as being present in more than half of all MRIs scanned at preset time intervals during an indefinite follow‑up period. Overall, 1,238 of 1,410 eligible patients with RT‑treated nonmetastatic NPC were evaluated. A total of 887 (71.6%) patients did not have MMD at diagnosis, but 746 (60.3%) patients had G2MMD at least once after RT. To identify the risk factors for PG2MMD, 817 patients with NPC without MMD pretreatment and nasopharyngeal recurrence from the greater cohort were analyzed. In this group, the incidences of G2MMD at 3, 6, 12, 24 and 60 months after RT were 26.2, 21.3, 21.4, 21.4 and 16.8%, respectively. The incidence of PG2MMD was 17.9% (146/817). Age >50 years [hazard ratio (HR), 1.699], female sex (HR, 1.594) and a mean dose of radiation to the mastoids (mastoid Dmean) >37.30 Gy (HR, 1.554) were the independent factors for PG2MMD (all P<0.05). In conclusion, in the large‑scale NPC cohort with long‑term follow‑up, most patients were not diagnosed with MMD prior to treatment, but more than half of those patients experienced MMD at least once during follow‑up. Of note, age >50 years, female sex and a high mastoid Dmean were positive independent risk factors for post‑RT PG2MMD. 
View Figures

Figure 1

MRI images of criteria and flowchart
of patient selection and study design. Representative MRIs of
patients with (A) Grade 0, (B) Grade 1 and (C) Grade 2 MMD (arrows)
after RT. Patients were stratified according to the presence or
absence of PG2MMD, which referred to at least half of ipsilateral
MRI-based mastoiditis scored Grade 2 after RT in patients with NPC.
(D) Flow chart of patient inclusion. The GARTP study
(ChiCTRROC-17012658) is a prospective observational clinical trial.
NPC, nasopharyngeal carcinoma; RT, radiotherapy; PG2MMD, persistent
grade 2 mastoid mucosa disease; MMD, mastoid mucosa disease.

Figure 2

Frequency of mastoid mucosa disease in
patients with nasopharyngeal carcinoma after radiotherapy. p,
pretreatment.

Figure 3

Risk factors for PG2MMD after RT in
patients with NPC. Cumulative event rate of PG2MMD with post-RT
time for patients with NPC stratified by (A) sex and (B) mastoid
Dmean. PG2MMD, persistent grade 2 mastoid mucosa disease; NPC,
nasopharyngeal carcinoma; RT, radiotherapy; Dmean, mean dose to the
ipsilateral mastoid.
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Copy and paste a formatted citation
Spandidos Publications style
Xie R, Chen S, Feng Z, Feng S, Hua P, Wu W, Duan X, Duan C, Lin C, Lv B, Lv B, et al: Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study. Oncol Lett 30: 406, 2025.
APA
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W. ... Liu, Y. (2025). Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study. Oncology Letters, 30, 406. https://doi.org/10.3892/ol.2025.15152
MLA
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W., Duan, X., Duan, C., Lin, C., Lv, B., Wu, J., You, R., Jia, W., Chen, M., Liu, Y."Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study". Oncology Letters 30.3 (2025): 406.
Chicago
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W., Duan, X., Duan, C., Lin, C., Lv, B., Wu, J., You, R., Jia, W., Chen, M., Liu, Y."Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study". Oncology Letters 30, no. 3 (2025): 406. https://doi.org/10.3892/ol.2025.15152
Copy and paste a formatted citation
x
Spandidos Publications style
Xie R, Chen S, Feng Z, Feng S, Hua P, Wu W, Duan X, Duan C, Lin C, Lv B, Lv B, et al: Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study. Oncol Lett 30: 406, 2025.
APA
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W. ... Liu, Y. (2025). Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study. Oncology Letters, 30, 406. https://doi.org/10.3892/ol.2025.15152
MLA
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W., Duan, X., Duan, C., Lin, C., Lv, B., Wu, J., You, R., Jia, W., Chen, M., Liu, Y."Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study". Oncology Letters 30.3 (2025): 406.
Chicago
Xie, R., Chen, S., Feng, Z., Feng, S., Hua, P., Wu, W., Duan, X., Duan, C., Lin, C., Lv, B., Wu, J., You, R., Jia, W., Chen, M., Liu, Y."Post‑irradiation mastoid mucosa disease in patients with nasopharyngeal carcinoma after radiotherapy: A large‑cohort and long‑term study". Oncology Letters 30, no. 3 (2025): 406. https://doi.org/10.3892/ol.2025.15152
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