Unusual computed tomography findings of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer: a case report

Abstract

IntroductionRadionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis) is a complication of (chemo) radiotherapy for hypopharyngeal cancer that is difficult to differentiate from tumor recurrence.Case presentationA 67-year-old Japanese man presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after radiotherapy for hypopharyngeal cancer. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathologic analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosal edema.ConclusionOur findings emphasize the wide spectrum of radiographic presentation of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer.

Higher radiation doses after partial laryngectomy may raise the incidence of pneumonia: A retrospective cohort study

“…It has been shown by later research that radiotherapy may cause local tissue hypoxia, which can result in tissue fibrosis, endarteritis, vascular blockage, and decreased blood flow. The physiological function of the larynx is impacted, and the anatomical structure of the larynx is destroyed when microcracks in the perichondrium expose the deep surface cartilage to the air, resulting in infection and ultimately radionecrosis of cartilage ( 7 , 17 – 19 ).…”

Condroradionecrose de laringe após radioterapia

“…Microfissures of the perichondrium (both internal and external) appear, exposing the cartilage in its deep face to the bacteria of the aero-digestive tract. Infection sets in, leading to chondroradionecrosis, which is then considered a late complication 18,25,37 . The first report of larynx chondronecrosis due to radiotherapy was by Goodrich and Lenz, in 1948 38 , and since then not many cases have been reported, up to the present time a total of seventyseven patients, without including those of the present study.…”

“…The tomographic findings of laryngeal changes during or shortly after radiotherapy are not able to rule out local recurrence. The findings are often nonspecific and the data in the literature are confusing, except for citing that the likelihood of relapse is greater within one year and that after this period the chance of chondroradionecrosis is higher 37,[39][40][41] . According to Hermans et al 40 , the local recurrence rate after radiotherapy is about 10% to 20% for T1 / T2 lesions and 40% to 50% for T3 / T4 lesions.…”

“…According to Hermans et al 40 , the local recurrence rate after radiotherapy is about 10% to 20% for T1 / T2 lesions and 40% to 50% for T3 / T4 lesions. Since recurrences are much more frequent than chondroradionecrosis, deep biopsies should be performed for restaging, although they may worsen the infection and local necrosis (14,37). Currently, this diagnostic dilemma can be resolved through PET-CT, in which tumor activity is evident in the larynx if relapse occurs, but examination should be done only three months after the end of radiotherapy to eliminate the interference of actinic inflammation [42][43][44] .…”

The Role of Bevacizumab in the Management of Head and Neck Squamous Cell Carcinoma Patients

“…Moreover, Levin et al indicated that bevacizumab is a treatment option in patients who suffer from radiation necrosis secondary to treatment of head, neck and brain cancers [11]. We previously reported a case of a 67-year-old Japanese man who presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after chemoradiotherapy for hypopharyngeal cancer [12]. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathological analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosa edema.…”