Evaluation of the perioperative safety and feasibility through
MDT
Currently, our hospital “Blinded for review” has established MDT,
whose core is the Department of Otorhinolaryngology, combined with the
Departments of Radiology, Radiotherapy, Neurology, Psychiatry,
Anesthesiology.
Radiotherapists, radiologists, and otorhinolaryngologists evaluated
the tumor control situation to exclude tumor residue, local
recurrence, and distant metastasis
According to the Chinese Society of Clinical Oncology (CSCO) clinical
guidelines for the diagnosis and treatment of NPC, nasopharyngoscopy and
nasopharyngeal and neck magnetic resonance imaging (MRI) scan were
employed to assess the local lesions. Besides, chest computed tomography
(CT) scan, abdominal ultrasound or upper abdominal CT, whole-body bone
scan, and detection of Epstein-Barr virus (EBV) DNA copy number in
peripheral blood were used to exclude distant post-treatment metastases.
When necessary, PET-CT examination should be
considered.2
Radiologists and otorhinolaryngologists assessed the severity of ORNTB
and otitis media
ORNTB was characterized as either localized or diffuse based on Ramsden
classification: 1) localized type: mostly limited to the external
auditory canal (EAC) without invading the mastoid bone of the middle
ear; 2) diffuse type: predominantly diffuse necrosis of the temporal
bone with a high risk of involvement of adjacent structures, in
particular the brain, labyrinth, and the facial nerve and to a lesser
extent the temporomandibular joint and the parotid
gland.10-13 Based on the Ramsden classification, the
surgeons and the radiologists planned the application of three different
surgical methods by assessing the intactness of the tympanic membrane
(TM) and the thickness and integrity of the cortical bone of the
posterior and upper wall of the EAC through the temporal bone CT
thin-layer scan on the horizontal section from the facial recess to the
base turn of cochlea.
Radiologists diagnosed radiation encephalopathy (REP) and assessed the
severity of REP; neurologists and psychologists evaluated patients’
cognitive function and psychological status.
Focal cerebral radiation necrosis, which is a type of REP, can occur
after incidental irradiation of the brain during NPC
treatment.14 The diagnosis of REP is based mainly on
NPC radiotherapy history, imaging examinations, clinical symptoms, and
cognitive functions. However, the clinical presentation of focal
radiation necrosis is a subacute space-occupying lesion, which is
nonspecific. Therefore, imaging examinations, such as standard MRI
scans, are the main diagnostic methods for REP (Fig.
1).15 The radiologists diagnosed REP and assessed the
severity of REP by MRI. Meanwhile, neurologists and psychologists
assisted in judging whether epilepsy and cognitive dysfunction caused by
REP were contraindications.
Anesthesiologists should evaluate patients’ perioperative situation
and the risk of anesthesia.
One of the most common complications after radiotherapy for NPC is
limitation of the mouth opening, which increases the difficulty of
endotracheal intubation and thus increases the risk of anesthesia. The
anesthesiologists used the modified Mallampati scores to divide the
patients into four classes. Nasotracheal intubation should be considered
in grades III and IV patients, whereas orotracheal intubation was
applied in grade I and II patients.16
Otorhinolaryngologists and audiologists evaluated the patients’
remaining hearing and speech abilities and predicted the postoperative
results.
All patients underwent preoperative audiological examination evaluation
for cochlear implant candidacy. Intraoperative audiologists routinely
performed neural response telemetry (NRT). Postoperative routine
reexamination of temporal bone CT was conducted to confirm the
electrode’s position in order to exclude the possibility of electrode
fracture, partial electrode implantation or implantation failure.