Chondroradionecrosis of the larynx: still a diagnostic dilemma

Abstract

Following radiation treatment for carcinoma of the larynx it may be very difficult to differentiate between persistent or recurrent tumour and severe radiation effects particularly chondroradionecrosis. Despite repeated negative biopsy it may be necessary to perform total laryngectomy where the concern about persistent cancer remains and the larynx is non-functioning. We report nine cases presenting as chondroradionecrosis over a five-year period. Two patients settled on medical treatment. Of seven patients treated with laryngectomy the histology on two revealed residual or recurrent carcinoma.We outline the dilemmas in diagnosis and propose management strategies to deal with this condition including recommendations for prevention and treatment.

Chondroradionecrosis of the Larynx: Diagnostic and Therapeutic Measures for Saving the Organ from Radiotherapy Sequelae

“…Chandler grade III and IV patients have serious complications and may progress despite aggressive treatment measures. The symptoms and signs are similar to those seen in recurrent laryngeal carcinoma, presenting a major diagnostic dilemma for clinicians (9, 12, 13). The CT appearance of laryngeal CRN is nonspecific and indistinguishable from that of tumor recurrence.…”

Condroradionecrose de laringe após radioterapia

“…There was also no consensus for the creation of a prospective study involving the treatment of chondroradionecrosis. The incidence of 10.7% of chondroradionecrosis in our cases is somewhat elevated when compared with the literature data, but can be explained by differences in the radiotherapy techniques of the different services [17][18][19] . Since the clinical signs and symptoms of chondroradionecrosis can be many, it was necessary to create severity ratings to guide treatment 23,24 .…”

“…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.…”

“…These changes, if left untreated and resolved, lead to the loss of the organ, with continuous broncho-aspiration, requiring rescue surgery, even in the absence of neoplasia 12,13,16 . Thus, with the increase in the indication of radiotherapy, there was also an increase in the rate of its complications, including laryngeal edema with hoarseness, dyspnea and bronchoaspiration, radiodermatitis (grades I and II), skin necrosis (grade III), simple chondritis, chondritis with Chondroradionecrosis as a complication has a variable incidence, ranging from 1% to 5.3%, resulting in rescue laryngectomies in up to 25% of cases [17][18][19] . It clinically progresses to dysphagia, odynophagia, fistula formation, hoarseness, partial or total dysfunction of the larynx, loss of airway protection with airway obstruction and bronchospasm.…”

Malignant tracheal necrosis and fistula formation following palliative chemoradiotherapy: a case report

“…This process is accelerated by inflammation caused by hypoxemia, infection from respiratory tract bacteria, and injury to the tracheal wall. Other predisposing factors are tumor invasion, smoking, and a high dose of radiation (10). This mechanism might explain why the breakdown of the perichondrial membrane by radiotherapy and traumatic injury allows respiratory bacteria to access the cartilage membrane and how such infected tissues then progresses to necrosis, abscessation, and finally fistula formation.…”