Osteoradionecrosis of the Occipitocervical Junction After Radiation for Head and Neck Cancer: A Report of 8 Cases.
Biopsy
Head and neck cancer
Occipitocervical junction
Osteoradionecrosis
Radiation
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
12
11
2019
revised:
21
02
2020
accepted:
22
02
2020
pubmed:
8
3
2020
medline:
24
7
2020
entrez:
8
3
2020
Statut:
ppublish
Résumé
Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN. Eight patients with a history of prior head and neck cancer, radiation therapy, and suspected ORN at the skull base, occipitocervical junction, and atlantoaxial spine were identified retrospectively from a single academic medical center. In 4 cases, MRI findings and PET imaging were negative for recurrence. One patient in this group underwent an aborted biopsy. Four patients had MRI concerning for infection or recurrent tumor with PET-positive lesions. Three patients in this group underwent biopsy that was negative for recurrent tumor. One patient developed an arteriovenous fistula after biopsy. The fourth patient was observed and did not demonstrate progression at 5 months. At last follow-up for all patients, there was no evidence of tumor recurrence or metastasis at the index site to indicate a misdiagnosis for recurrent tumor. This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.
Sections du résumé
BACKGROUND
Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN.
CASE DESCRIPTION
Eight patients with a history of prior head and neck cancer, radiation therapy, and suspected ORN at the skull base, occipitocervical junction, and atlantoaxial spine were identified retrospectively from a single academic medical center. In 4 cases, MRI findings and PET imaging were negative for recurrence. One patient in this group underwent an aborted biopsy. Four patients had MRI concerning for infection or recurrent tumor with PET-positive lesions. Three patients in this group underwent biopsy that was negative for recurrent tumor. One patient developed an arteriovenous fistula after biopsy. The fourth patient was observed and did not demonstrate progression at 5 months. At last follow-up for all patients, there was no evidence of tumor recurrence or metastasis at the index site to indicate a misdiagnosis for recurrent tumor.
CONCLUSIONS
This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.
Identifiants
pubmed: 32145424
pii: S1878-8750(20)30415-0
doi: 10.1016/j.wneu.2020.02.140
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
381-385Informations de copyright
Copyright © 2020. Published by Elsevier Inc.