Radionecrosis or tumor recurrence after radiation of laryngeal and hypopharyngeal carcinomas
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Los Angeles, CA, September 25-28, 2005.
Objective
To analyze the incidence and diagnostic difficulties of radionecrosis vs tumor recurrence of laryngeal and hypopharyngeal carcinomas.
Study design and setting
Retrospective study on 341 patients treated by radiation alone or radiochemotherapy. The clinicopathologic findings, work-up, treatment, and follow-up of 20 patients with symptoms suggestive but negative for tumor recurrence on initial imaging studies and endoscopy were analyzed.
Results
The incidence of chondroradionecrosis in 341 irradiated patients was 5%. Ten of 20 patients initially negative for tumor recurrence were treated by total laryngectomy; in all laryngectomy specimens, chondroradionecrosis was present, in six specimens associated with tumor recurrence. Ten patients were treated by tracheotomy and tumor recurrence was detected in one patient during follow-up.
Conclusion
Chondroradionecrosis is a relatively rare treatment complication. Typical imaging findings suggestive of radionecrosis are often missing. Tumor recurrence may be present beneath an intact mucosa and missed by endoscopy.
aDepartment of Oto-Rhino-Laryngology, Head, and Neck Surgery; University Hospital, Berne, Switzerland
bDepartment of Diagnostic, Interventional, and Pediatric Radiology; University Hospital, Berne, Switzerland
cDepartment of Radio-Oncology; University Hospital, Berne, Switzerland
dDepartment of Pathology; University Hospital, Berne, Switzerland
Reprint requests: P. Zbären, MD, Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, CH-3000 Berne, Switzerland.
ABSTRACT