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

Khorsandi, Azita S.; Su, Henry; Mourad, W.F.; Urken, Mark L.; Persky, Mark S.; Lazarus, Cathy L.; Jacobson, Adam S.

doi:10.1259/bjr.20140436

Cited by 23 publications

(28 citation statements)

References 13 publications

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“…Recently, MRI has been recommended as a very useful technique for the identi cation of benign and malignant vertebral diseases [32,33]. There are several studies have clari ed the value of MRI for diagnosis of ORN, displayed that cervical spine ORN could be misdiagnosed as bone metastasis, because cervical ORN could show soft-tissue masses and present abnormal enhancement [6,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, multicenter validation is needed to achieve strong evidence for its clinical application. Second, as described in previous studies [6,9,10], pathologic con rmation for cervical spine ORN and bone metastasis was not available attributed to the relatively high risks related to biopsy of the cervical spine (eg, injury to the vertebral artery or the cervical spinal cord). Third, only radiomics features are selected to construct a nomogram model, because the object of this study was cervical spine lesion, considering the fact that patients could involve single or multiple lesions, include patients' clinical factors could create selection bias.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cervical Spine Osteoradionecrosis or Bone Metastasis after Radiotherapy for Nasopharyngeal Carcinoma? The MRI-Based Radiomics for Characterization

Zhong

Jiang

et al. 2020

Preprint

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Background: To develop and validate an MRI-based radiomics nomogram for differentiation of cervical spine ORN from metastasis after radiotherapy (RT) in nasopharyngeal carcinoma (NPC).Methods: A radiomics nomogram was developed in a training set that comprised 46 NPC patients after RT with 95 cervical spine lesions (ORN, n = 51; metastasis, n = 44), and data were gathered from January 2008 to December 2012. 279 radiomics features were extracted from the axial contrast-enhanced T1-weighted image (CE-T1WI). A radiomics signature was created by using the least absolute shrinkage and selection operator (LASSO) algorithm. A nomogram model was developed based on the radiomics scores. The performance of the nomogram was determined in terms of its discrimination, calibration, and clinical utility. An independent validation set contained 25 consecutive patients with 47 lesions (ORN, n = 25; metastasis, n = 22) from January 2013 to December 2015.Results: The radiomics signature that comprised eight selected features was significantly associated with the differentiation of cervical spine ORN and metastasis. The nomogram model demonstrated good calibration and discrimination in the training set [AUC, 0.725; 95% confidence interval (CI), 0.622–0.828] and the validation set (AUC, 0.720; 95% CI, 0.573–0.867). The decision curve analysis indicated that the radiomics nomogram was clinically useful.Conclusions: MRI-based radiomics nomogram shows potential value to differentiate cervical spine ORN from metastasis after RT in NPC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical Spine Osteoradionecrosis or Bone Metastasis after Radiotherapy for Nasopharyngeal Carcinoma? The MRI-Based Radiomics for Characterization

Zhong

Jiang

et al. 2020

Preprint

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“…Since osteomyelitis and osteodiscitis are proposed to represent infectious complications of underlying ORN [16], patient 1 possibly initially suffered from this.…”

Section: Discussionmentioning

confidence: 99%

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

et al. 2018

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Background: Patients with squamous-cell carcinoma of the head and neck (SCCHN) on palliative therapy usually have a bad prognosis and suffer from various symptoms. With increasing use of targeted agents in cancer patients at the end of life, the correct assignment of therapy-related symptoms becomes increasingly difficult as cancer-related symptoms usually increase as well. Case Report: We report on 2 cases of patients with SCCHN who received multimodal treatment including palliative therapy with cetuximab. Both patients developed severe thoracic and cervicothoracic pain following treatment. In both cases, extensive paraspinal abscess formation proved to be the underlying cause. One patient was treated conservatively; the other one had to undergo surgical intervention. Conclusions: Awareness of multifaceted therapy-related complications is mandatory when patients receive multimodal treatment including targeted therapies. Unexplained pain syndromes in this context should raise suspicions concerning possible infectious complications and should lead to early use of magnetic resonance imaging.

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“…Literature review revealed 1 case presented by Ekbom et al 2 of a 56-year-old woman with a history of laryngeal cancer postradiation, esophageal dilation, and neck pain, who had negative findings on computed tomography examination, and was later diagnosed with osteomyelitis on magnetic resonance imaging. Magnetic resonance imaging has the highest specificity in diagnosing cervical osteomyelitis 5 ; however, the indications and timing of imaging for this patient population are not clear.…”

Section: To the Editormentioning

confidence: 99%

Cervical Osteomyelitis After Pharyngeal Surgical Manipulation

Govil

Schmitt

Kim

2016

JAMA Otolaryngol Head Neck Surg

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To the Editor We congratulate D'Souza and colleagues on their article, "Cervical Spine Spondylodiscitis After Esophageal Dilation in Patients With a History of Laryngectomy or Pharyngectomy and Pharyngeal Irradiation," 1 for bringing attention to a rare but potentially devastating complication of esophageal dilation in patients with postradiation head and neck cancer. We have observed similar events in our patients at the University of Pittsburgh.We can recall 3 cases of patients aged 52 to 74 years who developed cervical osteomyelitis after pharyngeal surgical manipulation. All patients had undergone radiation treatment for hypopharyngeal or laryngeal cancer. One patient underwent multiple direct laryngoscopic procedures and a biopsy procedure of an ulcerative pharyngeal wall lesion, and 2 patients had esophageal dilations for treatment of dysphagia. They presented 4 weeks to 24 weeks after the procedures with complaints of neck pain and were treated with a combination of surgical debridement and intravenous antibiotics. Unfortunately, all patients had diet limitations after treatment, with 2 patients remaining dependent on percutaneous endoscopic gastrostomy (PEG) tubes for nutrition.Similar to Dr D'Souza and colleagues, 1 we emphasize that no mucosal injuries or perforations were noted during the surgic al interventions. Esophageal dilation is a well-tolerated procedure, 2 but studies 3,4 show that it induces a transient bacteremia. Patients with postradiation head and neck cancer may develop occult mucosal injuries during dilations, which are prone to wound healing complications and infection. At our institution, we are considering starting prophylactic antibiotics prior to pharyngeal intervention in this patient population.Additionally, as in case number 4 in Dr D'Souza's article, 1 2 of our patients were "incidentally" diagnosed with cervical osteomyelitis on surveillance imaging. This implies that the diagnosis of osteomyelitis may often be missed. Literature review revealed 1 case presented by Ekbom et al 2 of a 56-year-old woman with a history of laryngeal cancer postradiation, esophageal dilation, and neck pain, who had negative findings on computed tomography examination, and was later diagnosed with osteomyelitis on magnetic resonance imaging. Magnetic resonance imaging has the highest specificity in diagnosing cervical osteomyelitis 5 ; however, the indications and timing of imaging for this patient population are not clear.We concur with D'Souza et al 1 that head and neck surgeons must maintain a high clinical suspicion for cervical osteomyelitis in any patient with postradiation cancer who has a history of recent pharyngeal surgery and presents with neck pain. Further research is necessary to elucidate the role of prophylactic antibiotics and imaging in preventing and diagnosing this rare complication.

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

Cited by 23 publications

References 13 publications

Cervical Spine Osteoradionecrosis or Bone Metastasis after Radiotherapy for Nasopharyngeal Carcinoma? The MRI-Based Radiomics for Characterization

Cervical Spine Osteoradionecrosis or Bone Metastasis after Radiotherapy for Nasopharyngeal Carcinoma? The MRI-Based Radiomics for Characterization

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

Cervical Osteomyelitis After Pharyngeal Surgical Manipulation

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