Radiation necrosis of the bone, cartilage or cervical soft-tissues following definitive high-precision radio(chemo)therapy for head-neck cancer: an uncommon and under-reported phenomenon

BackgroundThe impact of modern high-precision conformal techniques on rare but highly morbid late complications of head and neck radiotherapy, such as necrosis of the bone, cartilage or soft-tissues, is not well described.MethodMedical records of head and neck cancer patients treated in prospective...

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Bibliographic Details
Published in:Journal of laryngology and otology 2022-05, Vol.136 (5), p.447-453
Main Authors: Gupta, T, Maheshwari, G, Gudi, S, Chatterjee, A, Phurailatpam, R, Prabhash, K, Budrukkar, A, Ghosh-Laskar, S, Agarwal, J P
Format: Article
Language:English
Subjects:
Anti-inflammatory agents
Antibiotics
Cartilage
Clinical trials
Head & neck cancer
Hyperbaric oxygen therapy
Inflammation
Main Article
Medical records
Necrosis
Necrotizing fasciitis
Ostomy
Patients
Radiation therapy
Soft tissues
Tracheostomy
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Summary:BackgroundThe impact of modern high-precision conformal techniques on rare but highly morbid late complications of head and neck radiotherapy, such as necrosis of the bone, cartilage or soft-tissues, is not well described.MethodMedical records of head and neck cancer patients treated in prospective clinical trials of definitive high-precision radiotherapy were reviewed retrospectively to identify patients with necrosis.ResultsTwelve of 290 patients (4.1 per cent) developed radiotherapy necrosis at a median interval of 4.5 months. There was no significant difference in baseline demographic (age, gender), disease (primary site, stage) and treatment characteristics (radiotherapy technique, total dose, fractionation) of patients developing radiotherapy necrosis versus those without necrosis. Initial management included antibiotics or anti-inflammatory agents, tissue debridement and tracheostomy as appropriate followed by hyperbaric oxygen therapy and resective surgery for persistent symptoms in selected patients.ConclusionMultidisciplinary management is essential for the prevention, early diagnosis and successful treatment of radiotherapy necrosis of bone, cartilage or cervical soft tissues.
ISSN:0022-2151
1748-5460
DOI:10.1017/S0022215121003790