The Incidental Finding of Recurrent Carcinoma in Osteoradionecrosis Resection Specimens: A Consecutive Case Series

Purpose:

Osteoradionecrosis (ORN) is a well known and usually late complication of radiation therapy in the treatment of head and neck cancer. Due to the hypoxic, hypovascular, and hypocellular nature of these wounds resection combined with pedicled or free tissue transfer is often required to achieved definitive cure.Statistically the mandible is the most commonly affected site¹. In these resection specimens the incidental finding of malignancy has been documented but is somewhat rare. The aim of this review is to investigate the presence of recurrent carcinoma, sarcoma, or new primary malignancies in resection specimens previously diagnosed as ORN.

Methods:

A retrospective chart review was completed of 564 consecutive cases of ORN. Inclusion criteria included previous history of head and neck carcinoma treated with radiation of at least 6000 cGy, clinical diagnosis of ORN and surgical intervention with osseous resection for treatment of the ORN. A total of 564 patients were found to meet the inclusion criteria. The study endpoints measured include the microscopic evidence of malignancy in the osteoradionecrosis specimen and microscopic evidence of new primary in the foregut. This study has been reviewed and approved by the University of Miami-Miller School of Medicine institutional reviewed board.

Results: 

Of the 564 patients, 14 patients had microscopic evidence of cancer in the specimen (2.48%) and 4 had a proven second primary malignancy in the foregut (one in the lung 0.18% and there in the oropharynx 0.53%). 1 of the 14 patients was diagnosed with a high-grade sarcoma and died within 1 year of diagnosis.

Conclusion:

Although an relatively rare finding (2.48% in this study) the Oral and Maxillofacial Surgeon treating ORN should be cognizant about the potential of malignancy in this patient population and conduct their examinations and studies to investigate this potential. The differential diagnosis in Osteoradionecrosis cases should include a loco-regional recurrence, radiation induced malignancies and a metachronous primary malignancy. The treatment of malignant disease is different than osteoradionecrosis and a multidisciplinary treatment approach specific to the newly discovered malignancy is recommended if a malignancy is diagnosed in an ORN patient.