Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation.

Autor: Irizarry R; SUNY Downstate Medical Center, New York, New York, U.S.A., Shatzkes DR; Department of Head and Neck Radiology, Lenox Hill Hospital and the New York Head and Neck Institute, New York, New York, U.S.A., Teng S; Department of Otolaryngology, New York, New York, U.S.A., Kohli N; SUNY Downstate Medical Center, New York, New York, U.S.A., Har-El G; SUNY Downstate Medical Center, New York, New York, U.S.A.; Department of Otolaryngology, New York, New York, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2019 Apr; Vol. 129 (4), pp. 865-870. Date of Electronic Publication: 2018 Nov 19.
DOI: 10.1002/lary.27324
Abstrakt: Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN).
Methods: Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology.
Results: Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved.
Discussion: Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention.
Conclusion: Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation.
Level of Evidence: 4 Laryngoscope, 129:865-870, 2019.
(© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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