title: A case of hypopharyngeal cancer with stenosis, perforation, and pyogenic spondylitis development after chemoradiotherapy.
abstract: BACKGROUND
  Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to result in late complications, such as hypopharyngeal perforation, which is very rare.
  
  
  METHODS
  A 65-year-old man, who had undergone chemoradiotherapy for hypopharyngeal cancer 30 months previously, presented with high fever and neck pain. He subsequently developed hypopharyngeal stenosis, hypopharyngeal perforation, and a retropharyngeal abscess followed by pyogenic spondylitis. He underwent surgical treatment (resection with reconstruction) and was administered an antibacterial agent and steroids for an extended period. This treatment regimen was successful, and the patient has survived disease-free without symptoms.
  
  
  CONCLUSIONS
  Chemoradiotherapy-induced hypopharyngeal perforation is an extremely rare condition. In the present case, the perforation was large (2cm), and the hypopharyngeal cavity was originally constricted. Pharyngeal reconstruction with a jejunal autograft was therefore necessary. Through the present case, we reconfirmed that although the primary purpose of chemoradiotherapy is organ preservation, it can also lead to organ destruction and fatal complications. It is important that physicians be aware of the possibility of hypopharyngeal perforation so as to avoid delayed diagnosis and treatment of similar rare cases.
  
  
  CONCLUSIONS
  Hypopharyngeal perforation can sometimes be fatal because it can lead to pyogenic spondylitis. Suitable surgical techniques and appropriate doses of antibacterial agents for long-term use were appropriate treatments for the patient in this case.
authors.affiliation: Department of Head and Neck Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu City, Japan. Electronic address: miolovemio@hotmail.co.jp.
authors.forename: Mioko
authors.initials: M
authors.lastname: Matsuo
authors.affiliation: Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan. Electronic address: fumiriki@nk-cc.go.jp.
authors.forename: Fumihide
authors.initials: F
authors.lastname: Rikimaru
authors.affiliation: Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan. Electronic address: yhigaki@nk-cc.go.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Higaki
authors.affiliation: Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan. Electronic address: masuda.m@nk-cc.go.jp.
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Masuda
keywords: Chemoradiotherapy; Hypopharyngeal cancer; Pyogenic spondylitis
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