Efficacy of Flutamide in Nasopharyngeal Angiofibroma

Abstract

Objective To assess the efficacy and safety of Flutamide (androgen receptor blocker) as an adjuvant therapy for presurgical tumor volume reduction in cases of Juvenile Nasopharyngeal Angiofibroma (JNA). Methods Therapeutic trial, Janurary-December 2007. 10 previously untreated cases of JNA (Radkowski stage IIC-IIIB) were administered Flutamide (10 mg/kg in 3 divided doses) for 6 weeks prior to surgical excision. Pre- and post-therapy tumor volume assessment undertaken by MR Imaging. All cases had periodic liver function tests and assessment of primary and secondary sexual characteristics continuing till 6 months post-therapy. Results Pre-pubertal cases had inconsistent and minimal responses to Flutamide. All 7 post-pubertal cases (as indicated by age and serum testosterone levels) however, demonstrated consistent tumor volume reduction ranging from 6% to 35% (mean 16.6 %). Two cases with optic nerve compression had significant improvements in visual acuity and visual fields. No adverse effect was noted excepting for mild and transient breast tenderness. Conclusions Preoperative use of Flutamide is safe and leads to partial tumor regression in post-pubertal patients. The regression of the tumor away from adjacent vital structures may facilitate surgical excision and limit complications.