Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

Rachel Irizarry, Deborah R. Shatzkes, Stephanie Erh Shuen Teng, Nikita Kohli, Gady Har-El

Research output: Contribution to journalArticle

Abstract

Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN). Methods: Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology. Results: Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved. Discussion: Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention. Conclusion: Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation. Level of Evidence: 4 Laryngoscope, 129:865–870, 2019.

Original languageEnglish (US)
Pages (from-to)865-870
Number of pages6
JournalLaryngoscope
Volume129
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Fingerprint

Sternoclavicular Joint
Osteoradionecrosis
Radiation
Bone and Bones
Laryngoscopes
Hypopharynx
Neoplasms
Primary Myelofibrosis
Laryngectomy
Dyslipidemias
Blood Vessels
Comorbidity
Coronary Artery Disease
Drainage
Diabetes Mellitus
Neck
Radiotherapy
Myocardial Infarction
Tomography
Demography

Keywords

  • Osteoradionecrosis
  • head and neck radiation
  • osteonecrosis
  • sternoclavicular joint

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Irizarry, R., Shatzkes, D. R., Teng, S. E. S., Kohli, N., & Har-El, G. (2019). Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation. Laryngoscope, 129(4), 865-870. https://doi.org/10.1002/lary.27324

Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation. / Irizarry, Rachel; Shatzkes, Deborah R.; Teng, Stephanie Erh Shuen; Kohli, Nikita; Har-El, Gady.

In: Laryngoscope, Vol. 129, No. 4, 01.04.2019, p. 865-870.

Research output: Contribution to journalArticle

Irizarry, R, Shatzkes, DR, Teng, SES, Kohli, N & Har-El, G 2019, 'Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation', Laryngoscope, vol. 129, no. 4, pp. 865-870. https://doi.org/10.1002/lary.27324
Irizarry, Rachel ; Shatzkes, Deborah R. ; Teng, Stephanie Erh Shuen ; Kohli, Nikita ; Har-El, Gady. / Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation. In: Laryngoscope. 2019 ; Vol. 129, No. 4. pp. 865-870.
@article{8db6764ff68b4fb89e8a115a0dc748d9,
title = "Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation",
abstract = "Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN). Methods: Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology. Results: Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved. Discussion: Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention. Conclusion: Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation. Level of Evidence: 4 Laryngoscope, 129:865–870, 2019.",
keywords = "Osteoradionecrosis, head and neck radiation, osteonecrosis, sternoclavicular joint",
author = "Rachel Irizarry and Shatzkes, {Deborah R.} and Teng, {Stephanie Erh Shuen} and Nikita Kohli and Gady Har-El",
year = "2019",
month = "4",
day = "1",
doi = "10.1002/lary.27324",
language = "English (US)",
volume = "129",
pages = "865--870",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

AU - Irizarry, Rachel

AU - Shatzkes, Deborah R.

AU - Teng, Stephanie Erh Shuen

AU - Kohli, Nikita

AU - Har-El, Gady

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN). Methods: Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology. Results: Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved. Discussion: Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention. Conclusion: Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation. Level of Evidence: 4 Laryngoscope, 129:865–870, 2019.

AB - Objectives: Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN). Methods: Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology. Results: Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved. Discussion: Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention. Conclusion: Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation. Level of Evidence: 4 Laryngoscope, 129:865–870, 2019.

KW - Osteoradionecrosis

KW - head and neck radiation

KW - osteonecrosis

KW - sternoclavicular joint

UR - http://www.scopus.com/inward/record.url?scp=85057033999&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057033999&partnerID=8YFLogxK

U2 - 10.1002/lary.27324

DO - 10.1002/lary.27324

M3 - Article

C2 - 30450587

AN - SCOPUS:85057033999

VL - 129

SP - 865

EP - 870

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 4

ER -