Guidelines for Complications of Cancer Treatment Vol VIII Part B

ChondroradionecrosisIntroduction and incidenceRadiation induced chondronecrosis is a well documented butrelatively rare complication of irradiating laryngeal andhypopharyngeal tumours.Although the incidence of chondronecrosis by histology is seenin about 18-26% of laryngectomy specimens, 3-5% of theirradiated patients have symptoms attributable to it (inretrospect). Diagnosis is challenging and the condition isprobably under diagnosed and underreported due to similarityof symptoms and signs to those of a recurrence. A high indexof suspicion and repeated negative biopsies in spite ofpersisting symptoms and stable appearance on cross sectionalimaging point to the diagnosis. Absence of recurrence can bedefinitively concluded only on detailed histopathological studyof the laryngectomy specimen.PathogenesisIrradiation of the laryngeal cartilage leads to disrupted collagensynthesis, hypoxia and hypocellularity of the tissues which isunable to maintain its normal tissue turnover. Changes in thecartilage usually occur when the perichondrium is breached212