JUVENILE NASOPHARYNGEAL ANGIOFIBROMA - AN UPDATE OF THERAPEUTIC MANAGEMENT

Background. Juvenile nasopharyngeal angiofibroma (JNA) is a benign tum or of the nasopharynx composed of fibrous connective tissue and an abu ndance of endothelium-lined vascular spaces. The name of the disease i s derived from the fact that it occurs during adolescence, almost excl usively in boys. Methods. This study examines the natural characterist ics of JNA, the imaging techniques used to diagnose and stage the neop lasm, and the treatment approaches used to manage the disease. Results . Forty-three cases of JNA diagnosed and treated at The University of Texas M. D. Anderson Cancer Center over a 38-year period were reviewed for the study. The cases were divided into two groups, those occurrin g between 1955 and 1974 and those occurring between 1975 and 1991, to accurately represent the developments in diagnostic and treatment meth odology during those time periods. Conclusion. The results of our stud y show that: (1) the imaging techniques used after 1965 (angiography, computed tomography, and magnetic resonance imaging) greatly improve t he staging of JNA; (2) morbidity, recurrence, and intraoperative compl ications decrease when preoperative embolization and skull-based surgi cal approaches are used; and (3) surgical resection is the most common primary treatment, with chemotherapy and radiotherapy recommended as possible other options. (C) 1996 John Wiley & Sons, Inc.