Head and Neck Cancer Soft Tissue Radiation Necrosis - Diagnostic Challenge

Research output: Contribution to journalArticle

Abstract

A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.

Original languageEnglish (US)
Pages (from-to)e110-e112
JournalClinical nuclear medicine
Volume44
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Head and Neck Neoplasms
Necrosis
Radiation
Tongue
Disease Progression
Squamous Cell Carcinoma
Neoplasms
Neck
Air
Carcinoma
Therapeutics

Keywords

  • FDG PET/CT
  • contrasted CT
  • head and neck cancer
  • radiation necrosis
  • soft tissue

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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abstract = "A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.",
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AU - Williams, Hadyn T

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AB - A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.

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