Significance of Inflammation Marker of Radionecrosis in Laryngopharynx Cancer Treated With Radiation

Radiotherapy is an effective treatment modality for head and neck cancer; however, it is associated with various side effects. One of the most devastating complications in the laryngopharyngeal region is radionecrosis, which presents with various signs and symptoms and can significantly impair patients' quality of life. This study aimed to identify factors related to the occurrence of radionecrosis and to evaluate treatment outcomes based on clinical experience.

This retrospective study included patients diagnosed with laryngeal and hypopharyngeal cancer who received radiotherapy-based treatments as the initial modality at our tertiary referral center from January 2013 to December 2020.

A total of 219 patients were included, of whom 20 (9.1%) developed radionecrosis requiring admission for treatment (Chandler's grade 3 or 4). Univariate analysis revealed significant associations between radionecrosis and clinically advanced T stage, thyroid cartilage involvement, paraglottic invasion, primary treatment modality (radiotherapy alone vs. chemoradiotherapy), and mid-radiation neutrophil-to-lymphocyte ratio (optimal cutoff; 2.4). Among the 20 patients treated for radionecrosis, including those who received hyperbaric oxygen (HBO) therapy, nine recovered without surgery, four recovered only after surgery, and seven did not improve. Patients with better outcomes tended to receive HBO therapy earlier and exhibited lower mid-radiation NLR values.

Patients with an advanced tumor status and elevated mid-radiation NLR should be closely monitored for radionecrosis. This suggests that early intervention with HBO therapy may enhance the rate of organ preservation.