Radiation induced ulcers in the treatment of HNSCC – Risk factors and implications

 

Background Radiotherapy-related ulcers in the oncological treatment of tumors of the head and neck region (HNSCC) represent a major diagnostic and therapeutic challenge. The aim of this study is to establish prognostic parameters of ulcer development after radiotherapy for HNSCC and to derive risk stratification. In addition, key diagnostic, immunologic and therapeutic measures were evaluated.

Methods Clinicopathologic data of 300 patients with HNSCC who presented to the ENT clinic of the Klinikum rechts der Isar between January 2015 and November 2020 and received primary or adjuvant radiotherapy in the Department of Radiooncology were evaluated.

Results An ulcer was evident in 40 of the 300 (13.3%) patients. Statistically significant risk factors for an ulcer were chemotherapeutic treatment (p=0.0372), a total dose of>50 Gy and a boost of>70 Gy (p<0.01, p<0.01). Ulceration occurred significantly less frequently after flap surgery (p=0.0434). There was no significant difference in overall survival between the two groups. Imaging revealed an initial suspicion of malignancy in 52.5% of patients, and diagnostic panendoscopy was performed in 95.2% of these patients. Overall, this revealed recurrence in 2 of 40 cases (5.0%).

Conclusions Important predictive factors for the development of radiation-induced ulcers are the addition of chemotherapy, a high total dose, a strong boost to the primarius. Overall, patients with these risk factors should receive close clinical follow-up for early detection of ulcer development. Imaging performed often reveals evidence of recurrence, resulting in panendoscopy with only rare evidence of recurrence.

Publication History

Article published online:
19 April 2024

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