Unexpected radiation laryngeal necrosis after carbon ion therapy using conventional dose fractionation for laryngeal cancer.
Carbon ion therapy is a type of radiotherapy that can deliver high-dose radiation to a tumor while minimizing the dose delivered to organs at risk. Moreover, carbon ions are classified as high linear energy transfer radiation and are expected to be effective for even photon-resistant tumors. A 73-year-old man with glottic squamous cell carcinoma, T3N0M0, refused laryngectomy and received carbon ion therapy of 70 Gy (relative biological effectiveness) in 35 fractions. Three months after the therapy, the patient had an upper airway inflammation, and then laryngeal edema and pain occurred. Five months after the therapy, the airway stenosis was severe and computed tomography showed lack of the left arytenoid cartilage and exacerbation of laryngeal necrosis. Despite the treatment, 5 and a half months after the therapy, the laryngeal edema and necrosis had become even worse and the surrounding mucosa was edematous and pale. Six months after the therapy, pharyngolaryngoesophagectomy and reconstruction with free jejunal autograft were performed. The surgical specimen pathologically showed massive necrosis and no residual tumor. Three years after the carbon ion therapy, he is alive without recurrence. The first reported laryngeal squamous cell carcinoma case treated with carbon ion therapy resulted in an unexpected radiation laryngeal necrosis. Tissue damage caused by carbon ion therapy may be difficult to repair even for radioresistant cartilage; therefore, hollow organs reinforced by cartilage, such as the larynx, may be vulnerable to carbon ion therapy. Caution should be exercised when treating tumors in or adjacent to such organs with carbon ion therapy.
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo y_demizu@nifty.com.
Yusuke
Y
Demizu
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo.
Osamu
O
Fujii
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo.
Fumiko
F
Nagano
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo.
Kazuki
K
Terashima
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo.
Dongcun
D
Jin
Department of Radiology, Nishikobe Medical Center, Kobe, Hyogo.
Masayuki
M
Mima
Department of Otorhinolaryngology-Head and Neck Surgery, Matsue Red Cross Hospital, Matsue, Shimane.
Naoharu
N
Oda
Department of Otorhinolaryngology-Head and Neck Surgery, Matsue Red Cross Hospital, Matsue, Shimane.
Kaoru
K
Takeuchi
Department of Otorhinolaryngology-Head and Neck Surgery, Matsue Red Cross Hospital, Matsue, Shimane.
Makiko
M
Takeda
Department of Otorhinolaryngology-Head and Neck Surgery, Matsue Red Cross Hospital, Matsue, Shimane.
Kazuyuki
K
Ito
Department of Radiation Oncology, Ise Red Cross Hospital, Ise, Mie, Japan.
Nobukazu
N
Fuwa
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo.
Tomoaki
T
Okimoto
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D016629:Esophagectomy; D005931:Glottis / Q000473:pathology / Q000528:radiation effects; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D063193:Heavy Ion Radiotherapy / Q000009:adverse effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy*; D007825:Laryngectomy; D007830:Larynx / Q000473:pathology* / Q000528:radiation effects*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery; D010611:Pharyngectomy; D011832:Radiation Injuries / Q000209:etiology*; D000077195:Squamous Cell Carcinoma of Head and Neck
carbon ion therapy; laryngeal cancer; radiation laryngeal necrosis; radiotherapy; squamous cell carcinoma