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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e109-e112
DOI: 10.1055/a-2164-8637
Case Report

Anterior Skull Base Osteoradionecrosis in the Age of Intensity-Modulated Radiation Therapy: A Case Series

Nikitha Kosaraju
1   David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Huan Zhang
2   Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
,
Sharon Qi
3   Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
,
Robert Chin
3   Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
,
Marilene B. Wang
2   Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
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Abstract

Background Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues to be a rare, devastating, and hard to treat complication of radiotherapy. We present three cases of anterior skull base ORN in a cohort treated with intensity-modulated radiation therapy (IMRT).

Case Series Three patients developed anterior skull base ORN after receiving at least one round of IMRT. ORN was diagnosed through either nasal endoscopy or imaging findings. The first was a 59-year-old woman with a sinonasal squamous cell carcinoma. Her chemoradiation history was notable for reirradiation and a high dose of radiation (143.3 Gy). The second was a 55-year-old man with recurrent nasopharyngeal carcinoma, whose history was notable for a high dose of radiation (∼140 Gy) and for being reirradiated. The final patient was a 37-year-old woman with an unremarkable history who received radiotherapy (65.0 Gy) for an esthesioneuroblastoma. One patient was asymptomatic and did not receive ORN-specific therapy. The other two were treated with a combination of medical and surgical intervention with successful short-term outcomes (no evidence of infection).

Conclusion Anterior skull base ORN can be treated through conservative and surgical means to achieve successful short-term outcomes. Further investigation of long-term outcomes is warranted.

Keywords

osteoradionecrosis - skull base - sinonasal tumor - nasopharyngeal tumor - radiation therapy

Presentation

This study was presented at the AAO-HNSF 2022 Annual Meeting and OTO Experience, Philadelphia, Pennsylvania, September 10–14, 2022.




Publication History

Received: 10 August 2023

Accepted: 29 August 2023

Accepted Manuscript online:
01 September 2023

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Leonetti JP, Weishaar JR, Gannon D, Harmon GA, Block A, Anderson DE. Osteoradionecrosis of the skull base. J Neurooncol 2020; 150 (03) 477-482
    CrossrefPubMedGoogle Scholar
  • 2 Habib A, Hanasono MM, DeMonte F. et al. Surgical management of skull base osteoradionecrosis in the cancer population – treatment outcomes and predictors of recurrence: a case series. Oper Neurosurg (Hagerstown) 2020; 19 (04) 364-374
    CrossrefPubMedGoogle Scholar
  • 3 Frankart AJ, Frankart MJ, Cervenka B, Tang AL, Krishnan DG, Takiar V. Osteoradionecrosis: exposing the evidence not the bone. Int J Radiat Oncol Biol Phys 2021; 109 (05) 1206-1218
    CrossrefPubMedGoogle Scholar
  • 4 Owosho AA, Tsai CJ, Lee RS. et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the Memorial Sloan Kettering Cancer Center experience. Oral Oncol 2017; 64: 44-51
    CrossrefPubMedGoogle Scholar
  • 5 Morrissey D, Grigg R. Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg 2011; 81 (12) 876-879
    CrossrefPubMedGoogle Scholar
  • 6 Han P, Wang X, Liang F. et al. Osteoradionecrosis of the skull base in nasopharyngeal carcinoma: incidence and risk factors. Int J Radiat Oncol Biol Phys 2018; 102 (03) 552-555
    CrossrefPubMedGoogle Scholar
  • 7 Leonetti JP, Marzo SJ, Zender CA, Porter RG, Melian E. Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol 2010; 31 (04) 656-659
    CrossrefPubMedGoogle Scholar
  • 8 Marx RE. A new concept of its pathophysiology. Growth (Lakeland) 1983; 41 (05) 283-288
    PubMedGoogle Scholar
  • 9 Adel M, Chang KP. Using a nasoseptal flap for the reconstruction of osteoradionecrosis in nasopharyngeal carcinoma: a case report. J Otolaryngol Head Neck Surg 2016; 45 (01) 27
    CrossrefPubMedGoogle Scholar
  • 10 Chapchay K, Weinberger J, Eliashar R, Adler N. Anterior skull base reconstruction following ablative surgery for osteoradionecrosis: case report and review of literature. Ann Otol Rhinol Laryngol 2019; 128 (12) 1134-1140
    CrossrefPubMedGoogle Scholar
  • 11 Annane D, Depondt J, Aubert P. et al. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group. J Clin Oncol 2004; 22 (24) 4893-4900
    CrossrefPubMedGoogle Scholar
  • 12 Vudiniabola S, Pirone C, Williamson J, Goss AN. Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones. Int J Oral Maxillofac Surg 2000; 29 (06) 435-438
    CrossrefPubMedGoogle Scholar
  • 13 Lovin BD, Hernandez M, Elms H. et al. Temporal bone osteoradionecrosis: an 18-year, single-institution experience. Laryngoscope 2021; 131 (11) 2578-2585
    CrossrefPubMedGoogle Scholar
  • 14 Shaikh N, Makary CA, Ryan L, Reyes C. Treatment outcomes for osteoradionecrosis of the central skull base: a systematic review. J Neurol Surg B Skull Base 2021; 83 (Suppl. 02) e521-e529
    PubMedGoogle Scholar
  • 15 Spillinger A, Park K, Shenouda K, Folbe AJ. Endoscopic management of postradiation skull base osteoradionecrosis. Int Forum Allergy Rhinol 2020; 10 (12) 1329-1333
    CrossrefPubMedGoogle Scholar
  • 16 Huang XM, Zheng YQ, Zhang XM. et al. Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope 2006; 116 (09) 1626-1631
    CrossrefPubMedGoogle Scholar
  • 17 Agas RAF, Yu KKL, Sogono PGM. et al. Reirradiation for recurrent nasopharyngeal carcinomas: experience from an academic tertiary center in a low- to middle-income country. J Glob Oncol 2019; 5 (05) 1-14
    CrossrefPubMedGoogle Scholar
  • 18 Kacorzyk U, Rutkowski TW. The role of salvage in the management of patients with sinonasal squamous cell carcinoma. Biomedicines 2022; 10 (06) 1266
    CrossrefPubMedGoogle Scholar
  • 19 Niezgoda JA, Serena TE, Carter MJ. Outcomes of radiation injuries using hyperbaric oxygen therapy: an observational cohort study. Adv Skin Wound Care 2016; 29 (01) 12-19
    CrossrefPubMedGoogle Scholar
  • 20 Delanian S, Chatel C, Porcher R, Depondt J, Lefaix JL. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys 2011; 80 (03) 832-839
    CrossrefPubMedGoogle Scholar
  • 21 Hao S-P, Chen HC, Wei F-C, Chen C-Y, Yeh AR-M, Su J-L. Systematic management of osteoradionecrosis in the head and neck. Laryngoscope 1999; 109 (08) 1324-1327 , discussion 1327–1328
    CrossrefPubMedGoogle Scholar
  • 22 Baumann DP, Yu P, Hanasono MM, Skoracki RJ. Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification. Head Neck 2011; 33 (06) 800-807
    CrossrefPubMedGoogle Scholar
  • 23 Chang DW, Oh HK, Robb GL, Miller MJ. Management of advanced mandibular osteoradionecrosis with free flap reconstruction. Head Neck 2001; 23 (10) 830-835
    CrossrefPubMedGoogle Scholar