Vol.100 No.12 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 100 No. 12 December 2007
Treatment of Laryngeal Radionecrosis with
Hyperbaric Oxygen Therapy: A Case Report
Akiko T. Nishida, Nobumitsu Honda, Mika Tsujimura, Tsunemichi Adachi,
Nobuya Fujiki, Kouji Miyata and Hideyuki Fukushima
(Kitano Hospital)
Yoshiharu Kitani
(Kyoto University)
Laryngeal necrosis is a rare complication of radiotherapy for early-staged laryngeal or hypopharyngeal cancer. However, when it occurs, there is no definitive treatment and laryngectomy is frequently required. Here we present a case of advanced laryngeal necrosis (grade 4, Chandler classification) treated with hyperbaric oxygen (HBO) therapy.
A 60-year-old woman received radiotherapy with 64.8 Gy for early-staged hypopharyngeal cancer in combination with three courses of cisplatin (40 mg/body/week). She developed pharyngeal pain and progressive dyspnea because of laryngeal edema 3 months after the completion of radiotherapy, and received an emergent tracheostomy. In order to differentiate radiation injury from cancer recurrence, biopsies were obtained under direct laryngoscopy and showed intense necrosis without malignancy. Since laryngeal radionecrosis was presumed, the patient received HBO therapy at 2 atmospheres absolute (ATA) with 100％ O2 for 2 hours per session. After 20 HBO treatments, laryngeal edema improved and her clinical symptoms including pharyngeal pain, swallowing pain and dysphagia, were ameliorated significantly. However, decannulation has not been achieved because of bilateral vocal cord fixation. We considered that HBO therapy was effective in the present case and that HBO therapy should be recommended as a therapeutic option whenever laryngeal necrosis occurs and there is a chance to save the larynx.
Key words : laryngeal radionecrosis, hyperbaric oxygen, hypopharyngeal cancer