2016 Volume 67 Issue 4 Pages 283-288
Although applications of radiation to head and neck cancers have increased, laryngeal necrosis remains a serious complication. We describe two patients who developed laryngeal necrosis after neck radiotherapy. A 67-year-old male with vocal cord cancer (clinical T3N0M0) received radiotherapy (70 Gy) with cetuximab. Five months after radiotherapy, he underwent a tracheostomy because of airway obstruction. Prior imaging was unable to differentiate between radionecrosis of the larynx and tumor recurrence, so a laryngectomy was performed. Pathological examination revealed no malignant lesions. Another patient was a 79-year-old male with cecum cancer accompanied by neck lymph node metastasis. He received neck chemoradiotherapy (66 Gy), but by 44 months later the lymph node had regrown. One month after additional radiotherapy (54 Gy) was performed, he developed dysphagia and odor from his larynx. He received hyperbaric oxygen therapy, not surgery, for radionecrosis of the larynx, because common carotid artery invasion of the lymph node tumor was suspected. The symptoms of radionecrosis disappeared temporarily, but he finally died of cancer one month later. Since differentiating between radionecrosis of the larynx and tumor recurrence is difficult, laryngectomy tends to be selected as a method of diagnosis and treatment. Conservative treatments such as antibiotics, steroids or hyperbaric oxygen therapy can be performed if the patient's physical state is not good enough to permit surgery or the patient has a strong desire to preserve his or her larynx.
