Clinical features and outcomes of skull base osteoradionecrosis in nasopharyngeal carcinoma patients: A systematic review and meta-analysis

Background: Skull base osteoradionecrosis following radiotherapy for nasopharyngeal carcinoma is a potentially life-threatening complication. Assessing severity, prognosis and providing appropriate treatment for the condition can be clinically challenging. This systematic review evaluates factors associated with patient outcome. Methodology: A literature search of PubMed, Embase, MEDLINE and Cochrane databases was conducted in August 2024. Data was extracted for patients with skull base osteoradionecrosis caused by nasopharyngeal carcinoma. Results were presented by narrative synthesis or with statistical analysis. Results: 359 patients from 31 papers were included. The clivus and posterior nasopharyngeal wall were the most common subsites for osteoradionecrosis. We categorized subsites into posterior, roof and lateral areas. Subsite was not associated with ICA exposure or infection. Frequent symptoms include headache, foul odour and epistaxis. Foul odour was negatively associated with infection and epistaxis was highly associated with ICA exposure. The most common direct complication was CSF leak (18.2%), whereas the most common post-treatment complication was infection (43.8%). Carotid blowout was the most common cause of mortality (45.9%). Conclusions: Foul odour and epistaxis may predict cases of skull base osteoradionecrosis complicated by ICA exposure and infection. Further research is necessary to assess the significance of ORN subsite as a prognosticator or guide to treatment.