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？M0) with CRT. The patient was treated to 72？Gy 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？Gy. The last 12？Gy were given with 9？MEV electrons. The lower neck was treated with an AP field
References
[1]
L. Barnes, L. Y. Tse, J. L. Hunt, et al., “Tumours of the hypopharynx, larynx and trachea: introduction,” in World Health Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours, L. Barnes, J. Eveson, P. Reichart, and D. Sidransky, Eds., pp. 111–117, IARC Press, Lyon, France, 2005.
[2]
A. Vassileiou, P. V. Vlastarakos, D. Kandiloros, et al., “Laryngeal cancer: smoking is not the only risk factor,” B-ENT, vol. 8, no. 4, pp. 273–278, 2012.
[3]
J. Bernier, C. Domenge, M. Ozsahin et al., “Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer,” The New England Journal of Medicine, vol. 350, no. 19, pp. 1945–1952, 2004.
[4]
“Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer,” The New England Journal of Medicine, vol. 324, pp. 1685–1690, 1991.
[5]
W. M. Mendenhall, J. T. Parsons, A. A. Mancuso, et al., “Radiotherapy for squamous cell carcinoma of the supraglottic larynx: an alternative to surgery,” Head and Neck, vol. 18, pp. 24–35, 1996.
[6]
A. S. Baker, R. G. Ojemann, M. N. Swartz, and E. P. Richardson Jr., “Spinal epidural abscess,” The New England Journal of Medicine, vol. 293, no. 10, pp. 463–468, 1975.
[7]
R. L. Danner and B. J. Hartman, “Update on spinal epidural abscess: 35 cases and review of the literature,” Reviews of Infectious Diseases, vol. 9, no. 2, pp. 265–274, 1987.
[8]
C. E. Pereira and J. C. Lynch, “Spinal epidural abscess: an analysis of 24 cases,” Surgical Neurology, vol. 63, supplement 1, pp. S26–S29, 2005.
[9]
E. S. Nussbaum, D. Rigamonti, H. Standiford, Y. Numaguchi, A. L. Wolf, and W. L. Robinson, “Spinal epidural abscess: a report of 40 cases and review,” Surgical Neurology, vol. 38, no. 3, pp. 225–231, 1992.
[10]
D. P. Davis, R. M. Wold, R. J. Patel et al., “The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess,” Journal of Emergency Medicine, vol. 26, no. 3, pp. 285–291, 2004.
[11]
H.-J. Tang, H.-J. Lin, Y.-C. Liu, and C.-M. Li, “Spinal epidural abscess—experience with 46 patients and evaluation of prognostic factors,” Journal of Infection, vol. 45, no. 2, pp. 76–81, 2002.
[12]
M. Soehle, T. Wallenfang, O. Suess et al., “Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes,” Neurosurgery, vol. 51, no. 1, pp. 79–85, 2002.
[13]
M. L. Hlavin, H. J. Kaminski, J. S. Ross, and E. Ganz, “Spinal epidural abscess: a ten-year perspective,” Neurosurgery, vol. 27, no. 2, pp. 177–184, 1990.
[14]
E. Reihsaus, H. Waldbaur, and W. Seeling, “Spinal epidural abscess: a meta-analysis of 915 patients,” Neurosurgical Review, vol. 23, no. 4, pp. 175–204, 2000.
[15]
S. H. Khan, M. S. Hussain, R. W. Griebel, and S. Hattingh, “Title comparison of primary and secondary spinal epidural abscesses: a retrospective analysis of 29 cases,” Surgical Neurology, vol. 59, no. 1, pp. 28–33, 2003.
[16]
D. Rigamonti, L. Liem, P. Sampath et al., “Spinal epidural abscess: contemporary trends in etiology, evaluation, and management,” Surgical Neurology, vol. 52, no. 2, pp. 189–197, 1999.
[17]
N. Akalan and T. ？zgen, “Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases,” Acta Neurochirurgica, vol. 142, no. 1, pp. 17–23, 2000.
[18]
R. O. Darouiche, R. J. Hamill, S. B. Greenberg, S. W. Weathers, and D. M. Musher, “Bacterial spinal epidural abscess. Review of 43 cases and literature survey,” Medicine, vol. 71, no. 6, pp. 369–385, 1992.
[19]
R. O. Darouiche, “Spinal epidural abscess,” The New England Journal of Medicine, vol. 355, no. 19, pp. 2012–2020, 2006.
