Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus

Interdisciplinary challenges and aims of flap or graft reconstruction surgery of sinonasal cancers: What radiologists and radiation oncologists need to know

“…Long-term complications occurred in about 15% of cases and concern principally wound breakdown, plate extrusion or osteoradionecrosis. Bone flaps are known to be at higher risk for osteoradionecrosis than the native bone ( 7 ). Dose backscatter from plates and screws might result in increased dose to the native and flap segments at their junction and increased risk of osteonecrosis, but lack of data prevents any estimate of the risk.…”

“…Arterial thrombosis occurs early in the immediate postoperative setting whereas venous thrombosis occurs later, frequently after 72h. Necrosis of free flap is rarely due to radiation-induced damage of vascular anastomosis or thrombosis but often occurs in the early postoperative period and could be caused by the vessel quality, comorbidities or technical procedures ( 7 ). Perforator flaps would seem to be more robust to radiotherapy.…”

“…Understanding the postoperative imaging changes after head and neck cancer reconstructions is a challenge ( 6 , 7 ). Sinonasal reconstructions are all the more difficult to analyze on imaging due to their variable anatomy and versatility in the immediate postoperative setting of early complications or routine long-term follow-up.…”

Neoadjuvant Chemoradiotherapy for Oral Cavity Cancer: Predictive Factors for Response and Interim Analysis of the Prospective INVERT-Trial

“…However, local control rates for the subgroup of LA-OCC remain inferior to those of LA-HNSCC with most locoregional failures emerging in field of prior RT ( 6 – 8 ). Furthermore, high-dose, postoperative RT/CRT to the oral cavity is challenging following extensive reconstructive surgery and can be delayed due to prolonged postoperative recovery or possible complications associated with surgery ( 6 , 9 , 10 ). Also, better vascularization and oxygenation in the unoperated tissue is associated with increased radiosensitivity and early systemic therapy could potentially reduce metastatic spread of these tumors ( 11 ).…”

“…Also, better vascularization and oxygenation in the unoperated tissue is associated with increased radiosensitivity and early systemic therapy could potentially reduce metastatic spread of these tumors ( 11 ). Some rare complications, such as fibula transplant- or flap-necrosis related to RT could be avoided in case of preoperative treatment, and in case of occurrence, the necrotic jaw could be resected during surgery ( 9 ). To improve local tumor control and overcome some of the limitations of primary or postoperative radiotherapy (PORT), a limited number of retrospective and prospective studies investigated neoadjuvant RT/CRT in LA-OCC.…”