Management of laryngeal radionecrosis: Animal and clinical experience

Abstract

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

Chondroradionecrosis of larynx following radiotherapy for metastatic neck disease originating from oral carcinoma

“…In a pathological study by KEENE et al 6 on human laryngeal specimens, the overall incidence of chondroradionecrosis was 26%, although only 3% of them were clinically diagnosed. Review of the literature shows the expected incidence in current practice to be less than 1%, usually in those who smoke 9,10 . Chondroradionecrosis most frequently occurs within the first year of radical radiotherapy, but can develop many decades after initial treatment 2 .…”

Unexpected radiation laryngeal necrosis after carbon ion therapy using conventional dose fractionation for laryngeal cancer

“…Chondronecrosis, which occurs with loss of microvasculature and tissue ischemia, is an essential pathology in RLN. Cartilage itself has few blood vessels and rare proliferating cells, making it resistant to photon RT, whereas the perichondrium, from which the underlying cartilage receives its nutrient supply, is highly proliferative and sensitive to photon RT (30). Chondronecrosis follows perichondritis and/or breakdown of the overlying mucosa (31).…”

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

“…Although its incidence is small at approximately 1% [6,7]. It is predicted to increase with increasing use of concomitant chemoradiotherapy.…”