title: Soft Tissue Necrosis in Head and Neck Cancer Patients After Transoral Robotic Surgery or Wide Excision With Primary Closure Followed by Radiation Therapy.
abstract: Risk factors were evaluated for surgical bed soft tissue necrosis (STN) in head and neck cancer patients treated with postoperative radiation therapy (PORT) after transoral robotic surgery (TORS) or wide excision with primary closure. Sixty-seven patients were evaluated. STN was defined as ulceration and necrosis of the surgical bed or persistently unhealed high-grade acute mucositis with pain after PORT. The median RT dose of primary site was 63.6 Gy (range, 45-67.15 Gy) with 2 Gy/fx (range 1.8-2.2 Gy/fx). Total 41 patients (61.2%) were treated with concurrent chemoradiotherapy. The median follow-up period was 26 months. STN was diagnosed in 13 patients (19.4%). Most of the patients were treated with oral steroids, antibiotics, and analgesics and the lesions were eventually improved (median of 6 months after PORT). STN did not influence local control. A depth of invasion (DOI > 1.4 cm, odds ratio [OR] 14.04, p = 0.004) and maximum dose/fraction (CTVpmax/fx > 2.3 Gy, OR 6.344, p = 0.043) and grade 3 acute mucositis (OR 6.090, p = 0.054) were related to STN. The 12 (23.5%) of 51 oropharyngeal cancer patients presented STN, and the risk factors were DOI > 1.2 cm (OR 21.499, P = 0.005), CTVpmax/fx > 2.3 Gy (OR 12.972, P = 0.021) and grade 3 acute mucositis (OR 10.537, P = 0.052). Patients treated with TORS or WE with primary closure followed by PORT had a high risk of surgical bed STN. STN risk factors included DOI (>1.2-1.4 cm) and CTVpmax/fx (>2.3 Gy). Radiation therapy after TORS must be carefully designed to prevent STN.
authors.affiliation: From the Department of Radiation Oncology (YHL), Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Departments of Radiation Oncology (YSK), Radiology (SLJ), Nuclear medicine (IRY), Pathology (YSL), Otorhinolaryngology (MSK, DIS), Medical Oncology (JHK), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Department of Radiation Oncology (MJC), Kyung Hee University Hospital at Gangdong, Seoul, South Korea, and Department of Radiation Oncology (MY), Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Lee
authors.forename: Yeon Sil
authors.initials: YS
authors.lastname: Kim
authors.forename: Mi Joo
authors.initials: MJ
authors.lastname: Chung
authors.forename: Mina
authors.initials: M
authors.lastname: Yu
authors.forename: So Lyung
authors.initials: SL
authors.lastname: Jung
authors.forename: Ie Ryung
authors.initials: IR
authors.lastname: Yoo
authors.forename: Youn Soo
authors.initials: YS
authors.lastname: Lee
authors.forename: Min Sik
authors.initials: MS
authors.lastname: Kim
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Sun
authors.forename: Jin Hyung
authors.initials: JH
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D011832:Radiation Injuries / Q000473:pathology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors