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Abstract

Current treatment of head and and neck carcinomas includes also Radiation Therapy (RT). Control with RT allows the patient to retain a functioning organ in cases in which surgical cure may require an extensive demolition. Consequently a growing number of selected patients are treated with RT. To evaluate the CT appearance of laryngeal carcinomas treated with RT and the ability of Computed Tomography (CT) to differentiate persistent or residual tumor from radio-induced changes of soft tissues.

Pre- and post-treatment CT examinations (n = 325) of 132 patients with primary laryngeal cancers treated with RT (4500–7500 cGy) were retrospectively evaluated.

We subdivide the patients in three groups on the basis of the differences in the CT appearance of the primary tumors treated with RT 1) Responders (42): complete resolution of tumor or reduction in tumor size = or > 75%; 2) Non-Responders (55): persistent tumor or residual mass with reduction in tumor size — or < 50%. 3) Partial Responders (35): persistent residual mass with reduction in tumor size from 50% to 75% or persistent asimmetry of the mucosal surface.

There are some points to analyse in the interpretation of CT imaging of post-treated head and neck region: 1) Transient changes of irradiated soft tissues are more prominent during the first three month after RT. 2) Persistent changes are subgrouped in: a) Superficial (skin and platysmal thickening, reticulation of subcutaneous fat); b) Glandular (major salivary glands adenitis and fatty degeneration); c) Deep (reticulation and fibrous degeneration of anterior and posterior cervical and perivascular fat); d) Visceral (increased en-hancement of the pharyngeal mucosa and thickening of posterior pharyngeal wall, epiglottis, aryepiglottic folds, false vocal cords, anterior and posterior commissures, subglottic larynx, increased attenuation of paralaryngeal fat). 3) Progressive arytenoid cartilage sclerosis is indicative of a poor outcome. 4) The patients of the third group may be followed also with seriated CT, because they have a significant percentage of recurrence.

Keywords

laryngeal carcinoma CT x-ray therapy

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References

Amdur

Parsons

: Postoperative irradiation for squamous cell carcinoma of the head and neck: An analysis of treatment results and complications. Int J Radiation Oncology Biol Phys 16: 25–36, 1989.

Becker

Zbaren

: Neoplastic invasion of the laryngeal cartilage: Reassessment of criteria for diagnosis at CT. Radiology 203: 521–532, 1997.

Madison

Remley

: Radiologic diagnosis and staging of head and neck squamous cell carcinoma. Radiol Clin North Am 32: 163–181, 1994.

Mukherji

Mancuso

: Radiologic appearance of the irradiated larynx. Part I. Espected changes. Radiology 193: 141–148, 1994.

Mukherji

Mancuso

: Radiologic appearance of the irradiated larynx. Part II. Primary site response. Radiology 193: 149–154, 1994.

Munoz

Ramos

: Laryngeal carcinoma: Sclerotic appearance of crycoid and arytenoid cartilage — CT-pathologic correlation. Radiology 189: 433–437, 1993.

Roncallo

Turtulici

: Computed tomography and magnetic resonance in head and neck cancers. Part III. Indications for radiotherapy and treatment monitoring. Rivista di Neuroradiologia 9: 471–491, 1996.

Saleh

Mancuso

Stringer

: CT of submucosal and occult laryn-geal masses. J Comput Assist Tomogr 16(1): 87–93, 1992.

Shimm

: Early-stage glottic carcinomas: Effect of tumor location and full-length involvement on local tumor recurrence after radiation therapy. Radiology 192: 873–875, 1994.

10.

Smoker

WRK

and Harnsberger

: Differential diagnosis of head and neck lesions based on their space of origin 2. The infrahyoid portion of the neck. Am J Radiol 157: 155–159, 1991.

11.

Som

Urken

: Imaging of the postoperative neck. Radiology 187: 593–603, 1993.

12.

Stevens

Harnsberger

: Computed Tomography of cervical lymph nodes: Staging and management of head and neck cancer. Arch Otolaryngol Head Neck Surg 111: 735–739, 1985.

13.

Suojanen

Mukherji

Wippold

: Spiral CT of the larynx. Am J Neuroradiol 15: 1579–1582, 1994.

14.

Takashima

Noguchi

: Head and neck carcinoma: Detection of extraorgan spread with MR imaging and CT. Eur J Radiol 14: 228–234, 1992.

15.

Tart

Murkherji

: Value of laryngeal cartila-ge sclerosis as a predictor of outcome in patients with stage T3 glottic cancer treated with radiation therapy. Radiology 192: 567–570, 1994.

Laryngeal Carcinomas: CT Appearance after Radiation Therapy

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