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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
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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

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Footnotes

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

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