Guidelines for Complications of Cancer Treatment Vol VIII Part B

Arytenoid cartilage is reported to be the most commonlyaffected by histologic necrosis (51%) followed by thyroid ,cricoid and epiglottic cartilages at 34%, 9% and 3%respectivelyImagingThe CT appearance of laryngeal chondroradionecrosis is oftennonspecific. The soft-tissue and cartilaginous changesobserved in these patients can mimic local tumour recurrence.Progressive crico-arytenoidal sclerosis with surrounding softtissueswelling, anterior dislocation, and sloughing of thearytenoid may be signs of chondroradionecrosis. Gas bubblesaround the thyroid cartilage and fragmentation and collapseof the thyroid cartilage are highly suggestive of laryngealchondroradionecrosis.Although difficult, a PET CT scan provides additionalinformation to help in distinguishing tumour frominflammatory necrosis. Of particular utility is the ability toguide a confirmatory biopsy, when a focus of high tracer uptakeis seen surrounded by an area of milder uptake.ManagementThe initial management consists of antibiotics and antiinflammatory agents usually combined with steroids for allpatients.Chandler I and II chondroradionecrosis: Patients may bemanaged conservatively for 6-8 weeks with anti-inflammatoryagents and antibiotics. In addition, humidification, analgesiaand tube feeding help symptomatically and in tissue healing.Chandler III and IV chondroradionecrosis: A tracheotomy isoften needed in moderate to severe cases. A total laryngectomyis required in cases of proven tumour recurrences and in thosewith a functionless larynx with significant aspiration when215