Radiation-Induced Pharyngeal Necrosis and Cervical Spine Osteoradionecrosis in Patients With Oropharyngeal Squamous Cell Carcinoma

Background: Radiation therapy with or without chemotherapy is commonly used as an adjunct or alternative to surgery for treating head and neck cancer (HNC). In rare cases, radiation-induced side effects such as posterior pharyngeal wall necrosis, fistula formation, and osteoradionecrosis (ORN) can lead to dangerous complications of the cervical spine (C-spine). Methods: We conducted a literature review on C-spine ORN in HNC, and we reported four additional cases following the treatment of oropharyngeal carcinoma. Results: We identified 26 reported cases of C-spine ORN following radiation for HNC. Of the four cases from our institution, two were treated with surgical management and two with conservative measures. Two patients were able to resume oral intake. The median time to diagnosis was 121.5 (range: 22–194) months after completion of radiation. Conclusion: Late complications of radiation can be devastating, severely limiting functional status and quality of life. C-spine ORN is related to total radiation dose and should be discussed with patients as a rare but serious side-effect.