Guidelines for Complications of Cancer Treatment Vol VIII Part B

despite repeated negative biopsies recurrence has not beendocumented. More conservative surgical approaches includedebridement and a pedicled flap or submucosal resection ofthe necrotic cartilage.Role of Hyperbaric Oxygen: Administration of hyperbaricoxygen to necrotic tissues promotes healing by improvingoxygenation, enhancing collagen and fibroblast formation,stimulating leuckocyte and anti-infective activity and initiatingand promoting neovascularisation. Although protocols vary,preliminary data (London et al, Flintisis et al) has shownencouraging results with the use of hyperbaric oxygen withreduced need for laryngectomy and preservation of function.Flintisis et al., reported 18 patients with severechondroradionecrosis (2 had grade 3 and 16 had grade 4)treated with adjunctive hyperbaric oxygen therapy. Thirteenpatients (72.2%) had a major improvement after HBO therapy,and none of them required total laryngectomy. All patientspreserved their voice and deglutition in good or normalcondition.ReferencesZbären P, et al. Radionecrosis or tumor recurrence afterradiation of laryngeal and hypopharyngeal carcinomas.Otolaryngol Head Neck Surg. 2006 ; 135(6):838-43McGuirt WF. Laryngeal radionecrosis versus recurrent cancer.Otolaryngol Clin North Am. 1997 Apr;30(2):243-50.Keene M, Harwood AR, Bryce DP, van Nostrand AWP.Histopathological study of radionecrosis in laryngealcarcinoma. Laryngoscope 1982;92:173–180.J.R. Chandler, Radiation fibrosis and necrosis of the larynx,Ann Otol 88 (1979), pp. 509–514.216