{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T23:11:56Z","timestamp":1782169916918,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Post\u2010irradiation sinonasal mucosa disease (SMD) is observed in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT), leading to a detrimental impact on quality of life. This study aimed to assess the incidence, severity, and regression of the post\u2010irradiation SMD among patients with NPC treated with proton therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>NPC patients treated with proton therapy were retrospectively enrolled. The incidence of SMD was detected using scheduled follow\u2010up magnetic resonance images. The severity of SMD was evaluated using the Lund\u2013Mackay (L\u2013M) staging system. Localized inflammation of the nasopharynx was measured with the endoscopy score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 161 NPC patients were recruited. The incidence of SMD significantly increased from the third month to the first year after RT. The severity of SMD gradually decreased over time. Regression analyses showed that patients with pre\u2010treatment SMD (OR\u2009=\u20091.75; <jats:italic>p<\/jats:italic>\u2009=\u20090.005) and lower serum total protein (OR\u2009=\u20090.16; <jats:italic>p<\/jats:italic>\u2009=\u20090.01) were associated with persistence of SMD at 2\u2009years post\u2010RT. Correlations were observed between post\u2010RT L\u2010M and endoscopy scores (<jats:italic>r<\/jats:italic>\n<jats:sub>s<\/jats:sub>\u2009=\u20090.239, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). A high endoscopy score (cut\u2010off value, 1.5 [sensitivity, 87.5%; specificity, 49.2%]) predicted the persistence of SMD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Proton therapy in patients with NPC induces SMD, which peaked at 3\u2009months post\u2010RT, decreased gradually with time, and became insignificant at 2\u2009years post\u2010RT. Pre\u2010existence of SMD and lower serum total protein levels were factors associated with the persistence of post\u2010irradiation SMDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 135:1908\u20131914, 2025<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31974","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T12:25:29Z","timestamp":1734956729000},"page":"1908-1914","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Post\u2010irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated With Proton Therapy"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7549-9633","authenticated-orcid":false,"given":"Pei\u2010Wen","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology Chang Gung Memorial Hospital and Chang Gung University  Taoyuan Taiwan"},{"name":"School of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Che","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology Chang Gung Memorial Hospital and Chang Gung University  Taoyuan Taiwan"},{"name":"School of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8725-6209","authenticated-orcid":false,"given":"Po\u2010Hung","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology Chang Gung Memorial Hospital and Chang Gung University  Taoyuan Taiwan"},{"name":"School of Medicine Chang Gung University  Taoyuan 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