Osteoradionecrosis of the cervical spine: an analysis of the literature

Mañón, Victoria A.; ShumFACS, Jonathan

doi:10.1016/j.oooo.2022.08.019

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Of the nine treatment sites involving gross disease, five had CR and four had PR. Of the five treatment sites with CR ( 3 , 6 , 7 , 11 , 13 ), one tumor (no 6, a MCT) had microscopic evidence of residual disease, due to swelling of the non-evident tumor after fine-needle aspiration. This dog was still alive at the time of writing at 1266 days (≈3.5 years) post treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Another conclusion from these studies was that single fraction high dose (≥35 Gy to the 100% isodose and 30 Gy to the 90% isodose, respectively) FLASH RT should be considered unsafe for tumor treatment in the oral/nasal area and, consequently, that hypofractionated FLASH RT should be investigated as a mean to avoid the risk of severe late adverse effects to the bone. Yet, it is well-known that the bones of the oral cavity, and especially the mandible, are more sensitive to developing ORN compared to other body locations ( 11 ), and that electron dose distributions are affected by the tissue heterogeneities present in some parts of the oral cavity. Hence, the ORN observed in these studies may not be a general problem.…”

Section: Introductionmentioning

confidence: 99%

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Long-term toxicity and efficacy of FLASH radiotherapy in dogs with superficial malignant tumors

Gjaldbæk,

Arendt,

Konradsson

et al. 2024

Front. Oncol.

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IntroductionFLASH radiotherapy (RT) has emerged as a promising modality, demonstrating both a normal tissue sparing effect and anticancer efficacy. We have previously reported on the safety and efficacy of single fraction FLASH RT in the treatment of oral tumors in canine cancer patients, showing tumor response but also a risk of radiation-induced severe late adverse effects (osteoradionecrosis) for doses ≥35 Gy. Accordingly, the objective in this study was to investigate if single fraction high dose FLASH RT is safe for treating non-oral tumors.MethodsPrivately-owned dogs with superficial tumors or microscopic residual disease were included. Treatment was generally delivered as a single fraction of 15-35 Gy 10 MeV electron FLASH RT, although two dogs were re-irradiated at a later timepoint. Follow-up visits were conducted up to 12 months post-treatment to evaluate treatment efficiency and adverse effects.ResultsFourteen dogs with 16 tumors were included, of which nine tumors were treated for gross disease whilst seven tumors were treated post-surgery for microscopic residual disease. Four treatment sites treated with 35 Gy had ulceration post irradiation, which was graded as severe adverse effect. Only mild adverse effects were observed for the remaining treatment sites. None of the patients with microscopic disease experienced recurrence (0/7), and all patients with macroscopic disease showed either a complete (5/9) or a partial response (4/9). Five dogs were euthanized due to clinical disease progression.DiscussionOur study demonstrates that single fraction high dose FLASH RT is generally safe, with few severe adverse effects, particularly in areas less susceptible to radiation-induced damage. In addition, our study indicates that FLASH has anti-tumor efficacy in a clinical setting. No osteoradionecrosis was observed in this study, although other types of high-grade adverse effects including ulcer-formations were observed for the highest delivered dose (35 Gy). Overall, we conclude that osteoradionecrosis following single fraction, high dose FLASH does not appear to be a general problem for non-oral tumor locations. Also, as has been shown previously for oral tumors, 30 Gy appeared to be the maximum safe dose to deliver with single fraction FLASH RT.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term toxicity and efficacy of FLASH radiotherapy in dogs with superficial malignant tumors

Gjaldbæk,

Arendt,

Konradsson

et al. 2024

Front. Oncol.

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Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

Chen,

Bi,

Liu

et al. 2024

BMC Neurol

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Background Osteoradionecrosis (ORN) of the upper cervical spine is a rare but severe complication of head and neck cancer radiotherapy. To raise awareness of this condition, we describe a patient with a history of nasopharyngeal carcinoma who developed ORN of the upper cervical spine and review the published literature reporting surgical management. Case presentation A 59-year-old female patient with persistent neck pain for one month and limited range of neck motion who had undergone radiotherapy for nasopharyngeal carcinoma with a total dose of 69.96 Gy 15 years ago presented to our hospital. The patient underwent endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch, combined with occipitocervical fusion. To better understand surgical management of ORN of the upper cervical spine, the literature published in the PubMed, Ovid MEDLINE, and Embase databases was reviewed. Our patient experienced alleviation of cervical pain and did not exhibit any postoperative complications. Since 2005, 11 cases of surgical management of ORN of the upper cervical spine (including the present case) have been published. Basilar invagination and/or atlantoaxial subluxation were observed in 4 /11 cases. Endoscopic procedures were performed in 4/11 cases, and occipitocervical fusion was performed in 8 /11 cases. Conclusion Endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch is a safe and effective treatment option for ORN of the upper cervical spine. Occipitocervical fusion is useful in patients with basilar invagination and atlantoaxial subluxation.

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Post-radiotherapy osteomyelitis of the cervical spine in head and neck cancer patients

Tsur,

Segal,

Kurman

et al. 2023

BJR|Open

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Objective To evaluate patient characteristics, risk factors, disease course, and management of cervical vertebral osteomyelitis in patients who had radiation for head and neck cancers. Methods A retrospective cohort study (case series) of patients diagnosed with post-radiation osteomyelitis of the cervical spine between 2012 and 2021. Data were collected from the patient’s medical files. Results Seven patients (71% male) with post-radiation cervical osteomyelitis were reviewed. The median patient age was 64 years. The mean interval between diagnosis of osteomyelitis and the first and last radiotherapy course was 8.3 and 4.0 years, respectively. A medical or surgical event preceded the diagnosis in four patients (57%) by a mean of 46.25 days. Common imaging findings were free air within the cervical structures and fluid collection. Four patients recovered from osteomyelitis during the follow-up within an average of 65 days. Conclusion: Post-radiation osteomyelitis is characterized by a subtle presentation, challenging diagnosis, prolonged treatment, and poor outcome. Clinicians should maintain a high index of suspicion for the long-term after radiotherapy. Multidisciplinary evaluation and management are warranted. Advances in knowledge: The study describes post-radiotherapy osteomyelitis of the cervical spine, a rare and devastating complication. Literature data regarding this complication are sparse.

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Osteoradionecrosis of the cervical spine: an analysis of the literature

Cited by 3 publications

References 25 publications

Long-term toxicity and efficacy of FLASH radiotherapy in dogs with superficial malignant tumors

Long-term toxicity and efficacy of FLASH radiotherapy in dogs with superficial malignant tumors

Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

Post-radiotherapy osteomyelitis of the cervical spine in head and neck cancer patients

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