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Complications of Neck Radiation Therapy
Surjith Vattoth, MD, FRCR; Patricia A. Hudgins, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Uncommon, unintended side effects from radiation therapy (XRT) seen in small proportion of patients

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • FDG PET Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Acharya S et al: Risk assessment for osteoradionecrosis of the jaws in patients with head and neck cancer. Med Pharm Rep. 93(2):195-9, 2020
                                        2. Leonetti JP et al: Osteoradionecrosis of the skull base. J Neurooncol. 150(3):477-82, 2020
                                        3. Rigamonti A et al: Bilateral radiation-induced hypoglossal nerve palsy responsive to steroid treatment. J Clin Neurol. 14(2):244-5, 2018
                                        4. Ahmad S et al: Incidence of intracranial radiation necrosis following postoperative radiation therapy for sinonasal malignancies. Laryngoscope. ePub, 2016
                                        5. Tian YM et al: Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma. Head Neck. 38(2):225-31, 2016
                                        6. Nadella KR et al: Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update. J Maxillofac Oral Surg. 14(4):891-901, 2015
                                        7. Phillips DJ et al: Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
                                        8. Varoquaux A et al: Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors. Radiographics. 35(5):1502-27, 2015
                                        9. Rotteveel LJ et al: Incus necrosis after irradiation. Otol Neurotol. 34(9):1699-702, 2013
                                        10. Saito N et al: Posttreatment CT and MR imaging in head and neck cancer: what the radiologist needs to know. Radiographics. 32(5):1261-82; discussion 1282-4, 2012
                                        11. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                                        12. Horky LL et al: Dual phase FDG-PET imaging of brain metastases provides superior assessment of recurrence versus post-treatment necrosis. J Neurooncol. 103(1):137-46, 2011
                                        13. Glastonbury CM et al: The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol. 195(2):W164-71, 2010
                                        14. Madrid C et al: Osteoradionecrosis: an update. Oral Oncol. 46(6):471-4, 2010
                                        15. Dirix P et al: Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 75(2):385-92, 2009
                                        16. Lang K et al: Incidence and costs of treatment-related complications among patients with advanced squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 135(6):582-8, 2009
                                        17. Murphy BA et al: Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage. 38(4):522-32, 2009
                                        18. Paraskevas KI et al: Irradiation-induced carotid artery stenosis: a preventable complication of neck radiotherapy? Angiology. 60(3):273-5, 2009
                                        19. Toda K et al: Radiation-induced cancer after radiotherapy for non-Hodgkin's lymphoma of the head and neck: a retrospective study. Radiat Oncol. 4:21, 2009
                                        20. Truong MT et al: Emerging applications of stereotactic radiotherapy in head and neck cancer. Neurosurg Focus. 27(6):E11, 2009
                                        21. Yoo JS et al: Osteoradionecrosis of the Hyoid Bone: Imaging Findings. AJNR Am J Neuroradiol. Epub ahead of print, 2009
                                        22. Corvò R: Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol. 85(1):156-70, 2007
                                        23. Amemiya K et al: The risk of radiation-induced cancer in patients with squamous cell carcinoma of the head and neck and its results of treatment. Br J Radiol. 78(935):1028-33, 2005
                                        24. Zackrisson B et al: A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol. 42(5-6):443-61, 2003
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Uncommon, unintended side effects from radiation therapy (XRT) seen in small proportion of patients

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • FDG PET Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Acharya S et al: Risk assessment for osteoradionecrosis of the jaws in patients with head and neck cancer. Med Pharm Rep. 93(2):195-9, 2020
                                                                              2. Leonetti JP et al: Osteoradionecrosis of the skull base. J Neurooncol. 150(3):477-82, 2020
                                                                              3. Rigamonti A et al: Bilateral radiation-induced hypoglossal nerve palsy responsive to steroid treatment. J Clin Neurol. 14(2):244-5, 2018
                                                                              4. Ahmad S et al: Incidence of intracranial radiation necrosis following postoperative radiation therapy for sinonasal malignancies. Laryngoscope. ePub, 2016
                                                                              5. Tian YM et al: Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma. Head Neck. 38(2):225-31, 2016
                                                                              6. Nadella KR et al: Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update. J Maxillofac Oral Surg. 14(4):891-901, 2015
                                                                              7. Phillips DJ et al: Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
                                                                              8. Varoquaux A et al: Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors. Radiographics. 35(5):1502-27, 2015
                                                                              9. Rotteveel LJ et al: Incus necrosis after irradiation. Otol Neurotol. 34(9):1699-702, 2013
                                                                              10. Saito N et al: Posttreatment CT and MR imaging in head and neck cancer: what the radiologist needs to know. Radiographics. 32(5):1261-82; discussion 1282-4, 2012
                                                                              11. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                                                                              12. Horky LL et al: Dual phase FDG-PET imaging of brain metastases provides superior assessment of recurrence versus post-treatment necrosis. J Neurooncol. 103(1):137-46, 2011
                                                                              13. Glastonbury CM et al: The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol. 195(2):W164-71, 2010
                                                                              14. Madrid C et al: Osteoradionecrosis: an update. Oral Oncol. 46(6):471-4, 2010
                                                                              15. Dirix P et al: Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 75(2):385-92, 2009
                                                                              16. Lang K et al: Incidence and costs of treatment-related complications among patients with advanced squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 135(6):582-8, 2009
                                                                              17. Murphy BA et al: Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage. 38(4):522-32, 2009
                                                                              18. Paraskevas KI et al: Irradiation-induced carotid artery stenosis: a preventable complication of neck radiotherapy? Angiology. 60(3):273-5, 2009
                                                                              19. Toda K et al: Radiation-induced cancer after radiotherapy for non-Hodgkin's lymphoma of the head and neck: a retrospective study. Radiat Oncol. 4:21, 2009
                                                                              20. Truong MT et al: Emerging applications of stereotactic radiotherapy in head and neck cancer. Neurosurg Focus. 27(6):E11, 2009
                                                                              21. Yoo JS et al: Osteoradionecrosis of the Hyoid Bone: Imaging Findings. AJNR Am J Neuroradiol. Epub ahead of print, 2009
                                                                              22. Corvò R: Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol. 85(1):156-70, 2007
                                                                              23. Amemiya K et al: The risk of radiation-induced cancer in patients with squamous cell carcinoma of the head and neck and its results of treatment. Br J Radiol. 78(935):1028-33, 2005
                                                                              24. Zackrisson B et al: A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol. 42(5-6):443-61, 2003