Laryngeal Cartilage Necrosis after Laser surgery and Radiotherapy

Late toxicities of radiotherapy are defined as symptoms which occur three months or later after the end of irradiation. Well known laryngeal problems secondary to radiotherapy include secondary interstitial edema of the soft tissue, inflammation of the perichondrial tissue, atrophy or fibrosis of the skin, as wellas a fibrosis of the mucosa or soft tissue [1-3]. Typically, the laryngeal region will be included in the irradiation fields of patients with cancer of the larynx, hypopharynx or upper esophagus. We know some predisposing factors for higher rates of late complications, such as combined treatment modalities, higher irradiation doses >60 Gy, local infections, pre-existing cartilage infiltration by the tumor or a poor patient immune system [4-5]. In 1979 [6] described approximately 12% serious reactions after radiotherapy of the larynx. Cartilage necrosis was included [6]. 15 years later [1] observed decreased complication rates nearly 1%. They stressed new radio-techniques as the base for this positive development. Another development of this period is the launching of new multimodal therapy approaches, which has improved the rates of organ preservatio as well as new forms of acute and late toxicities.