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Expected Changes of Neck Radiation Therapy
Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Radiation therapy (XRT)
            • Intensity-modulated radiation therapy (IMRT)
              • Reduces radiation dose to uninvolved surrounding tissues & organs
          • Definitions

            • Expected changes in imaging appearances of neck following XRT

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Ravanelli M et al: Magnetic resonance imaging features of the superior cervical ganglion and expected changes after radiation therapy to the head and neck in a long-term follow-up. Neuroradiology. 62(4):519-24, 2020
                                    2. El Beltagi AH et al: Functional magnetic resonance imaging of head and neck cancer: performance and potential. Neuroradiol J. 32(1):36-52, 2019
                                    3. Traylor KS et al: Squamous cell carcinoma: PET/CT and PET/MRI of the pretreatment and post-treatment neck. Semin Ultrasound CT MR. 40(5):400-13, 2019
                                    4. Bird T et al: Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European single institution analysis. Clin Otolaryngol. ePub, 2016
                                    5. Gutiontov SI et al: Intensity-modulated radiotherapy for head and neck surgeons. Head Neck. 38 Suppl 1:E2368-73, 2016
                                    6. Huang TL et al: Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non-intensity-modulated radiotherapy. Head Neck. 38 Suppl 1:E1026-32, 2016
                                    7. Tol JP et al: A longitudinal evaluation of improvements in radiotherapy treatment plan quality for head and neck cancer patients. Radiother Oncol. 119(2):337-43, 2016
                                    8. Kraaijenga SA et al: Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 51(8):787-94, 2015
                                    9. 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
                                    10. Zhang LL et al: The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy: A Retrospective Study in an Endemic Area. Medicine (Baltimore). 94(31):e1294, 2015
                                    11. Gunn GB et al: Advances in radiation oncology for the management of oropharyngeal tumors. Otolaryngol Clin North Am. 46(4):629-43, 2013
                                    12. Glastonbury CM et al: The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol. 195(2):W164-71, 2010
                                    13. 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
                                    14. Popovtzer A et al: Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationships: MRI-based study. Radiother Oncol. 93(3):510-5, 2009
                                    15. Truong MT et al: Emerging applications of stereotactic radiotherapy in head and neck cancer. Neurosurg Focus. 27(6):E11, 2009
                                    16. Hermans R: Posttreatment imaging in head and neck cancer. Eur J Radiol. 66(3):501-11, 2008
                                    17. Corvò R: Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol. 85(1):156-70, 2007
                                    18. Zackrisson B et al: A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol. 42(5-6):443-61, 2003
                                    19. Wu Q et al: The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study. Int J Radiat Oncol Biol Phys. 46(1):195-205, 2000
                                    20. Teh BS et al: Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. Oncologist. 4(6):433-42, 1999
                                    21. Mukherji SK et al: Radiologic appearance of the irradiated larynx. Part I. Expected changes. Radiology. 193(1):141-8, 1994
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Radiation therapy (XRT)
                                              • Intensity-modulated radiation therapy (IMRT)
                                                • Reduces radiation dose to uninvolved surrounding tissues & organs
                                            • Definitions

                                              • Expected changes in imaging appearances of neck following XRT

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Nuclear Medicine Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Ravanelli M et al: Magnetic resonance imaging features of the superior cervical ganglion and expected changes after radiation therapy to the head and neck in a long-term follow-up. Neuroradiology. 62(4):519-24, 2020
                                                                      2. El Beltagi AH et al: Functional magnetic resonance imaging of head and neck cancer: performance and potential. Neuroradiol J. 32(1):36-52, 2019
                                                                      3. Traylor KS et al: Squamous cell carcinoma: PET/CT and PET/MRI of the pretreatment and post-treatment neck. Semin Ultrasound CT MR. 40(5):400-13, 2019
                                                                      4. Bird T et al: Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European single institution analysis. Clin Otolaryngol. ePub, 2016
                                                                      5. Gutiontov SI et al: Intensity-modulated radiotherapy for head and neck surgeons. Head Neck. 38 Suppl 1:E2368-73, 2016
                                                                      6. Huang TL et al: Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non-intensity-modulated radiotherapy. Head Neck. 38 Suppl 1:E1026-32, 2016
                                                                      7. Tol JP et al: A longitudinal evaluation of improvements in radiotherapy treatment plan quality for head and neck cancer patients. Radiother Oncol. 119(2):337-43, 2016
                                                                      8. Kraaijenga SA et al: Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 51(8):787-94, 2015
                                                                      9. 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
                                                                      10. Zhang LL et al: The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy: A Retrospective Study in an Endemic Area. Medicine (Baltimore). 94(31):e1294, 2015
                                                                      11. Gunn GB et al: Advances in radiation oncology for the management of oropharyngeal tumors. Otolaryngol Clin North Am. 46(4):629-43, 2013
                                                                      12. Glastonbury CM et al: The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol. 195(2):W164-71, 2010
                                                                      13. 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
                                                                      14. Popovtzer A et al: Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationships: MRI-based study. Radiother Oncol. 93(3):510-5, 2009
                                                                      15. Truong MT et al: Emerging applications of stereotactic radiotherapy in head and neck cancer. Neurosurg Focus. 27(6):E11, 2009
                                                                      16. Hermans R: Posttreatment imaging in head and neck cancer. Eur J Radiol. 66(3):501-11, 2008
                                                                      17. Corvò R: Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol. 85(1):156-70, 2007
                                                                      18. Zackrisson B et al: A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol. 42(5-6):443-61, 2003
                                                                      19. Wu Q et al: The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study. Int J Radiat Oncol Biol Phys. 46(1):195-205, 2000
                                                                      20. Teh BS et al: Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. Oncologist. 4(6):433-42, 1999
                                                                      21. Mukherji SK et al: Radiologic appearance of the irradiated larynx. Part I. Expected changes. Radiology. 193(1):141-8, 1994