Osteoradionecrosis after Radiation Therapy for Head and Neck Cancer: Differentiation from Recurrent Disease with CT and PET/CT Imaging

Alhilali, Lea; Reynolds, Anthony; Fakhran, Saeed

doi:10.3174/ajnr.a3879

Cited by 47 publications

(49 citation statements)

References 22 publications

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“…Although recurrent/metastatic disease generally demonstrates higher SUVs than does ORN, significant overlap in the ranges of observed SUVs in individual cases renders PET imaging unreliable in differentiating ORN from malignancy. 4 In our experience, PET/CT imaging lacks specificity in the identification of ORN in the spine. In both of our cases where PET/CT was performed, the studies were initially misinterpreted as recurrent disease.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Alhilali et al 4 suggest that bony sclerosis is a useful imaging feature on CT for differentiating ORN from recurrent tumour in the mandible, as it was seen exclusively in cases of ORN.…”

Section: Discussionmentioning

confidence: 99%

“…1 The imaging and clinical presentation of mandibular ORN varies, ranging from asymptomatic bone erosion to severe necrosis, bone exposure, orocutaneous fistulas, periodontal disease, local or systemic sepsis, and/or pathological fracture. 4 Similarly, patients with ORN of the cervical spine may be asymptomatic but can exhibit symptoms, including progressive neck pain, progressive kyphosis, paraesthesia, infectious symptoms, discitis, OM and compression of the vertebrae and spinal cord. 5,7,8 We propose that OM and discitis are end-stage manifestations of advanced ORN in the subaxial cervical spine.…”

Section: Discussionmentioning

confidence: 99%

“…3 The presentation of mandibular ORN ranges from asymptomatic bone erosion to severe bone and soft-tissue necrosis, bone exposure, orocutaneous fistulas, periodontal disease and/or pathological fracture. 4 Like the mandible and maxilla, the cervical spine lies within the irradiated field for head and neck cancer therapy, placing the poorly vascularized disc space and vertebrae at an increased risk of ischaemia and infection. ORN of the cervical spine is rare and has not been thoroughly studied.…”

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confidence: 99%

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Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas

Khorsandi¹,

Su²,

Mourad³

et al. 2015

BJR

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Objective: To study MRI and positron emission tomography (PET)/CT imaging of osteoradionecrosis (ORN) of the subaxial cervical spine, a serious long-term complication of radiation therapy (RT) for head and neck cancers that can lead to pain, vertebral instability, myelopathy and cord compression. Methods: This is a single-institution retrospective review of patients diagnosed and treated for ORN of the subaxial cervical spine following surgery and radiation for head and neck cancer. Results: We report PET/CT imaging and MRI for four patients, each with extensive treatment for recurrent head and neck cancer. Osteomyelitis (OM) and discitis are the end-stage manifestations of ORN of the subaxial spine.Conclusion: ORN of the subaxial spine has variable imaging appearance and needs to be differentiated from recurrent or metastatic disease. Surgical violation of the posterior pharyngeal wall on top of the compromised vasculature in patients treated heavily with RT may pre-dispose the subaxial cervical vertebrae to ORN, with possible resultant OM and discitis. MRI and PET/CT imaging are complimentary in this setting. PET/CT images may be misinterpreted in view of the history of head and neck cancer. MRI should be utilized for definitive diagnosis of OM and discitis in view of its imaging specificity. Advances in knowledge: We identify the end-stage manifestation of ORN in the sub-axial spine on PET/CT and MRI to facilitate its correct diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas

Khorsandi¹,

Su²,

Mourad³

et al. 2015

BJR

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“…Radiation complications such as osteoradionecrosis may mimic disease ( Figure 8) and PET imaging should always be interpreted in the context of anatomical imaging findings and clinical examination. 74 The imperfect specificity of FDG PET-CT in the post-treatment setting has stimulated interest in the use of alternative tracers, which correlate more closely with mechanisms involved in tumour treatment response or radiotherapy resistance. Tumour hypoxia is known to promote radiotherapy resistance.…”

Section: Lung Carcinomamentioning

confidence: 99%

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Cliffe

Patel

Prestwich

et al. 2017

The British Journal of Radiology

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Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases, salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon the anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy. Combined positron emission tomography (PET) and CT imaging employs radioactive tracers to identify molecular characteristics of tissues. PET imaging exploits the fact that malignancies have characteristic molecular profiles which differ compared with surrounding tissues. The complementary anatomical and functional information facilitates accurate non-invasive assessment of surrogate biomarkers of disease activity.This article reviews the rationale for positron emission tomography (PET)-CT response assessment in radiation oncology, describing current uses of 2-[18 F]-fluoro-2-deoxy-D-glucose (FDG) PET-CT in treatment response following radiotherapy in head and neck, oesophageal, rectal and brain tumours. Emerging applications of FDG PET-CT in cervical and lung carcinomas and hepato-pancreatico-biliary tumours, particularly pancreatic carcinoma and liver metastases (post-selective internal radiotherapy treatment), are reviewed. Finally, the limitations of FDG PET-CT are considered, highlighting areas for future development.

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Skull base osteomyelitis in patients with head and neck cancer: Diagnosis, management, and outcomes in a case series of 23 patients

Czech

Hwang

Colevas

et al. 2022

Laryngoscope Investig Oto

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Background: Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well-recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. Methods:We conducted a retrospective chart review of HNC patients diagnosed with SBO.Results: SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/ oropharyngeal flora, but half of the patients additionally had antibiotic-resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/À 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base.Conclusions: Diagnosis and management of SBO in HNC patients are challenging.Recommendations to aid in clinical care are proposed.Level of evidence: 4, case series.head and neck cancer, nasopharyngeal carcinoma, osteoradionecrosis, skull base osteomyelitis | INTRODUCTIONSkull base osteomyelitis (SBO) is an infection of the central cranial bones, involving parts of the sphenoid, occipital, and/or temporal bones. These infections most commonly result from contiguous extension of infection from the ear, paranasal sinuses, and/or nasooropharyngeal cavity. 1,2 SBO is classically and most commonly described in patients with uncontrolled diabetes who have otitis externa complicated by temporal bone osteomyelitis with extension into the central skull base. 3,4 However, SBO is increasingly being described in other patient populations.Our clinical experience demonstrates a significant number of SBO cases occurring in patients with head and neck cancer (HNC), though there are only limited case reports describing SBO in HNC patients. 5,6 Patients with HNC have underlying anatomic abnormalities resulting from tumor destruction, surgical intervention(s), and/or

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Osteoradionecrosis after Radiation Therapy for Head and Neck Cancer: Differentiation from Recurrent Disease with CT and PET/CT Imaging

Abstract: BACKGROUND AND PURPOSE:Our aim was to compare the CT and PET/CT imaging features of osteoradionecrosis with those of recurrent disease after treatment of head and neck malignancy.

Cited by 47 publications

References 22 publications

Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas

Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Skull base osteomyelitis in patients with head and neck cancer: Diagnosis, management, and outcomes in a case series of 23 patients

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