Adjuvant therapy with flutamide for presurgical volume reduction in juvenile nasopharyngeal angiofibroma.

Abstract

Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen treatment with flutamide on juvenile nasopharyngeal angiofibroma (JNA), it is not part of contemporary practice. Our approach was through a prospective, single-arm, before-and-after study, in which 20 patients with advanced JNA (Radkowski stage IIB-IIIB) were administered flutamide (per oral: 10 mg kg(-1) day(-1) × 6 weeks) prior to surgical excision. Pretherapy and posttherapy tumor volume measurements were established by MRI. Periodic assessments were recorded of liver, kidney functions, testosterone levels, and secondary sexual characteristics. Prepubertal and postpubertal cases responded differently (p < .05). Prepubertal cases had inconsistent and minimal responses; 13/15 postpubertal cases demonstrated measurable volume reduction (mean, 16.5%; maximum, 40%). Two cases with optic nerve compression had visual improvement. Volume reduction correlated with serum testosterone level (r = .53; p < .05). No significant toxicity was noted, with the exception of transient breast tenderness. Prepubertal and postpubertal patients differ in their response to flutamide. In postpubertal patients, 6 weeks preoperative use is safe and leads to partial tumor regression. Tumor regression from adjacent vital structures may facilitate surgical excision and limit morbidity.