title: Radionecrosis of the frontal lobe as a consequence of malignant ethmoid tumor management: incidence, diagnosis, risk factors, prevention and management.
abstract: Malignant ethmoid tumors are treated by surgery followed by radiotherapy. This study aimed to evaluate the incidence, risk factors and outcome of radionecrosis of frontal lobe and determine preventive measures. Retrospective study of ethmoid malignancies treated from 2000 to 2011. All patients underwent surgery with/without anterior skull base resection using endoscopic or external approaches followed by irradiation (mean dose 64 Gy). Median follow-up was 50 months. Eight of 50 patients (16 %) presented with fronto-basal radionecrosis, connected to duraplasty, with a latent interval of 18.5 months. Although asymptomatic in six, radionecrosis triggered seizures and required surgery in two cases. Survival was not impacted. Risk factors included dyslipidemia, occurrence of epilepsy and dural resection. Radionecrosis may result from the combination of anterior skull base resection and radiotherapy for the treatment of ethmoid malignancies. Preventive measures rely on improving the duraplasty and optimization of the Gy-dose delivery.
authors.affiliation: Head and Neck Surgery Department (Service d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou), Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France, n.oker@hotmail.fr.
authors.forename: N
authors.initials: N
authors.lastname: Oker
authors.forename: P
authors.initials: P
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Bresson
authors.forename: B
authors.initials: B
authors.lastname: George
authors.forename: J-P
authors.initials: JP
authors.lastname: Guichard
authors.forename: M
authors.initials: M
authors.lastname: Wassef
authors.forename: E
authors.initials: E
authors.lastname: Sauvaget
authors.forename: S
authors.initials: S
authors.lastname: Froelich
authors.forename: R
authors.initials: R
authors.lastname: Kania
authors.forename: P
authors.initials: P
authors.lastname: Herman
mesh_terms: D019468:Disease Management; D005004:Ethmoid Bone / Q000473:pathology / Q000601:surgery; D005260:Female; D005602:France / Q000453:epidemiology; D005625:Frontal Lobe / Q000528:radiation effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000528:radiation effects*; D012888:Skull Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery
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