Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-19T03:49:35.144Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  26 November 2021

T Gupta Open the ORCID record for T Gupta [Opens in a new window] ,
G Maheshwari ,
S Gudi ,
A Chatterjee ,
R Phurailatpam ,
K Prabhash ,
A Budrukkar ,
S Ghosh-Laskar  and
J P Agarwal
T Gupta*
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
G Maheshwari
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
S Gudi
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
A Chatterjee
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
R Phurailatpam
Affiliation:
Department of Medical Physics, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
K Prabhash
Affiliation:
Department of Medical Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
A Budrukkar
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
S Ghosh-Laskar
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
J P Agarwal
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
*
Author for correspondence: Dr T Gupta, Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai410210, India E-mail: [email protected] Fax: +91 22 274 05061
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The 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.

Method

Medical 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.

Results

Twelve 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.

Conclusion

Multidisciplinary management is essential for the prevention, early diagnosis and successful treatment of radiotherapy necrosis of bone, cartilage or cervical soft tissues.

Keywords

Head-Neck CancerMorbidityNecrotizing FasciitisRadionecrosisRadiotherapy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 5 , May 2022 , pp. 447 - 453
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr T Gupta takes responsibility for the integrity of the content of the paper

References

Pignon, JP, le Maître, A, Maillard, E, Bourhis, J. MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4–14CrossRefGoogle Scholar
Bentzen, SM, Trotti, A. Evaluation of early and late toxicities in chemoradiation trials. J Clin Oncol 2007;25:4096–103CrossRefGoogle ScholarPubMed
Ge, X, Liao, Z, Yuan, J, Mao, D, Li, Y, Yu, E et al. Radiotherapy-related quality of life in patients with head and neck cancers: a meta-analysis. Support Care Cancer 2020;28:2701–12CrossRefGoogle ScholarPubMed
Gupta, T, Kannan, S, Ghosh-Laskar, S, Agarwal, JP. Systematic review and meta-analyses of intensity-modulated radiation therapy versus conventional two-dimensional and/or or three-dimensional radiotherapy in curative-intent management of head and neck squamous cell carcinoma. PLoS One 2018;13:e0200137CrossRefGoogle ScholarPubMed
Chen, AM, Farwell, DG, Luu, Q, Vazquez, EG, Lau, DH, Purdy, JA. Intensity-modulated radiotherapy is associated with improved global quality of life among long-term survivors of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2012;84:170–5CrossRefGoogle ScholarPubMed
Marx, RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983;41:283–8CrossRefGoogle ScholarPubMed
Sciubba, JJ, Goldenberg, D. Oral complications of radiotherapy. Lancet Oncol 2006;7:175–83CrossRefGoogle ScholarPubMed
Aarup-Kristensen, S, Hansen, CR, Forner, L, Brink, C, Eriksen, JG, Johansen, J. Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations. Acta Oncol 2019;58:1373–7CrossRefGoogle ScholarPubMed
Gevorgyan, A, Wong, K, Poon, I, Blanas, N, Enepekides, DJ, Higgins, KM. Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg 2013;42:46CrossRefGoogle ScholarPubMed
Delanian, S, Lefaix, JL. The radiation-induced fibroatrophic process; therapeutic perspective via the antioxidant pathway. Radiother Oncol 2004;73:119–23CrossRefGoogle ScholarPubMed
Zbären, P, Caversaccio, M, Thoeny, HC, Nuyens, M, Curschmann, J, Stauffer, E. Radionecrosis or tumor recurrence after radiation of laryngeal and hypopharyngeal carcinomas. Otolaryngol Head Neck Surg 2006;135:838–43CrossRefGoogle ScholarPubMed
Oppenheimer, RW, Krespi, YP, Einhorn, RK. Management of laryngeal radionecrosis: animal and clinical experience. Head Neck 1989;11:252–6CrossRefGoogle ScholarPubMed
Chandler, JR. Radiation fibrosis and necrosis of the larynx. Ann Otol Rhinol Laryngol 1979;88:509–14CrossRefGoogle ScholarPubMed
Calcaterra, TC, Stern, F, Ward, PH. Dilemma of delayed radiation injury of the larynx. Ann Otol Rhinol Laryngol 1972;81:501–7CrossRefGoogle ScholarPubMed
Filntisis, GA, Moon, RE, Kraft, KL, Farmer, JC, Scher, RL, Piantadosi, CA. Laryngeal radionecrosis and hyperbaric oxygen therapy: report of 18 cases and review of the literature. Ann Otol Rhinol Laryngol 2000;109:554–62CrossRefGoogle ScholarPubMed
Keene, M, Harwood, AR, Bryce, DP, van Nostrand, AW. Histopathological study of radionecrosis in laryngeal carcinoma. Laryngoscope 1982;92:173–80CrossRefGoogle ScholarPubMed
Mortimore, S, Thorp, M. Cervical necrotizing fasciitis and radiotherapy: a report of two cases. J Laryngol Otol 1998;112:298–300CrossRefGoogle ScholarPubMed
Klabacha, ME, Stankiewicz, JA, Clift, SE. Severe soft tissue infection of the face and neck: a classification. Laryngoscope 1982;92:1135–9CrossRefGoogle ScholarPubMed
Lee, IJ, Koom, WS, Lee, CG, Kim, YB, Yoo, SW, Keum, KC et al. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2009;75:1084–91CrossRefGoogle ScholarPubMed
Mendenhall, WM. Mandibular osteoradionecrosis. J Clin Oncol 2004;22:4867–8CrossRefGoogle ScholarPubMed
Oh, HK, Chambers, MS, Martin, JW, Lim, HJ, Park, HJ. Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 2009;67:1378–86CrossRefGoogle ScholarPubMed
Wahl, MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys 2006;64:661–9CrossRefGoogle ScholarPubMed
Chronopoulos, A, Zarra, T, Troltzsch, M, Mahaini, S, Ehrenfeld, M, Otto, S. Osteoradionecrosis of the mandible: a ten year single-center retrospective study. J Craniomaxillofac Surg 2015;43:837–46CrossRefGoogle Scholar
Kuo, TJ, Leung, CM, Chang, HS, Wu, CN, Chen, WL, Chen, GJ et al. Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: a nationwide population-based retrospective study in Taiwan. Oral Oncol 2016;56:71–7CrossRefGoogle ScholarPubMed
Davis, DD, Hanley, ME, Cooper, JS. Osteoradionecrosis. In: https://www.ncbi.nlm.nih.gov/books/NBK430818/ [23 June 2020]Google Scholar
Frankart, AJ, Frankart, MJ, Cervenka, B, Tang, AL, Krishnan, DG, Takiar, V. Osteoradionecrosis: exposing the evidence not the bone. Int J Radiat Oncol Biol Phys 2021;109:1206–18CrossRefGoogle Scholar
Goodrich, WA, Lenz, M. Laryngeal chondronecrosis following roentgen therapy. Am J Roentgenol Radium Ther 1948;60:22–8Google ScholarPubMed
Roh, JL. Chondroradionecrosis of the larynx: diagnostic and therapeutic measures for saving the organ from radiotherapy sequelae. Clin Exp Otorhinolaryngol 2009;2:115–19CrossRefGoogle ScholarPubMed
Halkud, R, Shenoy, AM, Naik, SM, Pasha, T, Chavan, P, Sidappa, KT. Chondroradionecrosis of larynx a delayed complication of radiotherapy: management and review of literature. Indian J Surg Oncol 2014;5:128–33CrossRefGoogle ScholarPubMed
Gessert, TG, Britt, CJ, Maas, AMW, Wieland, AM, Harari, PM, Hartig, GK. Chondroradionecrosis of the larynx: 24-year University of Wisconsin experience. Head Neck 2017;39:1189–94CrossRefGoogle ScholarPubMed
Farneti, D, Fabbri, C, Prencipe, SR. Chondroradionecrosis of the larynx. Curr Opin Otolaryngol Head Neck Surg 2019;27:463–6CrossRefGoogle ScholarPubMed
Hermans, R, Pameijer, FA, Mancuso, AA, Parsons, JT, Mendenhall, WM. CT findings in chondroradionecrosis of the larynx. AJNR Am J Neuroradiol 1998;19:711–18Google ScholarPubMed
Greven, KM, Williams, DW III, Keyes, JW Jr, McGuirt, WF, Watson, NE Jr, Case, LD. Can positron emission tomography distinguish tumor recurrence from irradiation sequelae in patients treated for larynx cancer? Cancer J Sci Am 1997;3:353–7Google ScholarPubMed
Umbert, IJ, Winkelman, RK. Necrotizing fasciitis: a clinical, microbiologic and histopathologic study of 14 patients. J Am Acad Dermatol 1988;20:788–90Google Scholar