%0 Journal Article
%T Late Prevertebral and Spinal Abscess following Chemoradiation for Laryngeal Squamous Cell Carcinoma
%A Jawad Hindy
%A Ilan Shelef
%A Yuval Slovik
%A Ben-Zion Joshua
%J Case Reports in Otolaryngology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/425724
%X Objective. Advanced primary supraglottic tumors (i.e., T3 or T4) have traditionally been treated surgically and postoperative radiotherapy. In the last 2 decades, some patients were treated with chemoradiation avoiding surgery. Case Report. We describe a 55-year old female who presented with respiratory distress and paraplegia seven years after treatment for a T3N0M0 supraglottic squamous cell carcinoma. CT scan showed prevertebral and intraspinal air descending from C4 to D3 vertebras. Epidural and prevertebral abscesses were confirmed by neck exploration. Necrosis was observed in the retropharyngeal, prevertebral, and vertebral tissues. Conclusion. Prevertebral and spinal abscess may result from chemotherapy and radiotherapy to the head and neck. Physicians caring for head and neck cancer patients treated with chemotherapy and radiation should be aware of this rare severe complication. 1. Introduction Squamous cell carcinoma (SCC) is the most common malignant tumor of the larynx, responsible for between 85% and 95% of all laryngeal malignancies [1]. Common known risk factors for laryngeal cancer including smoking, alcohol, coffee consumption, and diesel exhaust fumes [2]. In Israel, Supraglottic SCC is less frequent than glottic SCC and account for 40% of laryngeal carcinomas. Majority of the lesions in supraglottic SCC are seen either on the epiglottis, false cords, or aryepiglottic folds. A number of therapeutic options are available for supraglottic SCC. Early-stage disease (stage I and II) is generally treated with single modality therapy, either surgery or radiotherapy (RT), whereas advanced disease (stage III and IV) is generally treated with combined modality therapy, either primary surgery followed by RT or chemoradiotherapy (CRT) [3], or primary CRT [4, 5]. Common complications of RT include dysphagia, aspiration, laryngeal edema, and chondronecrosis [5]. We present a case of an extremely rare complication of chemoradiation for supraglottic SCC. 2. Case Report A 55-year old female was transferred to our hospital from another hospital suffering from respiratory distress and paraplegia. Past medical history: 7 years prior to hospitalization she was treated for a supraglottic SCC (T3N1£żM0) with CRT. The patient was treated to 72£żGy total using a 3-field arrangement with subsequent cone-down technique. Radiation was delivered via 6-MV photons generated by a Varian linear accelerator. The tumor was treated with 2 lateral fields limiting the cord to 46£żGy. The last 12£żGy were given with 9£żMEV electrons. The lower neck was treated with an AP field
%U http://www.hindawi.com/journals/criot/2014/425724/