DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163798

A study of the effect of pre-radiation on healing of surgical wounds in the treatment of cancers of the head and neck

Sayandev Dasgupta, Arup Dasgupta, Supratik Sen, Sukanta Sen, P. K. Dutta, Samir Kr Sen

Abstract


Background: Radiation therapy is an established modality in the treatment of head and neck cancer patients. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to affect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. Compromised wound healing in irradiated tissues is a common and challenging clinical problem.

Methods: A prospective observational study was done in a tertiary care teaching institute, Kolkata. The effect of radiation on surgery of cancers of head and neck was studied in 50 patients. The patients were divided into 2 groups of 25 each. The cases in the first group were irradiated prior to surgery and those on the second group were operated upon without any pre-radiation.

Results: The highest incidence of wound complications in those patients who were operated upon within 2 weeks to 6 months of completion of RT (83.33%). Patients who had their blood Hb level at or above 11 gm% developed less number of wound complications (34.78%) as compared to those who had their blood Hb level between 8-11 gm% where complication rate was 48.15%. Those patients who had their oral cavity or pharynx opened during surgery had a much higher incidence of wound complications (54.54%) than whose oral cavity or pharynx were not interfered with (17.64%). Wound infection was 36% in the irradiated group and 12% in the non-irradiated group. Separation of wound edges or skin necrosis followed in 28% cases in the pre-radiated group and in 8% cases in the non-pre-radiated group.

Conclusions: Radiotherapy is an integral modality of head and neck cancer therapy. Compromised wound healing is an important side effect of radiation therapy. All sorts of local complications as wound infection and necrosis, or ocutaneous fistulae, carotid artery perforation etc. are more pronounced in patients, who received prior radiotherapy. The complication of surgery after radiotherapy was found to be more pronounced between 2 weeks to 6 months in this series.


Keywords


Complications, Effect of radiation, Head and neck cancers, Radiation therapy, Wounds healing

Full Text:

PDF

References


Dormand EL, Banwell PE, Goodacre TE. Radiotherapy and wound healing. Int Wound J. 2005;2:112-27.

Gieringer M, Gosepath J, Naim R. Radiotherapy and wound healing: Principles, management and prospects. Oncol Rep. 2011;26:299-307.

O’Sullivan B, Rumble RB, Warde P. Members of the IMRT Indications Expert Panel. Intensity modulated Radiotherapy in the Treatment of Head and Neck Cancer. Clin Oncol (R Coll Radiol). 2012;24:474-87.

Marks JE, Freeman RB, Lee F, Ogura JH. Pharyngeal wall cancer: an analysis of treatment results complications and patterns of failure. Int J Radiat Oncol Biol Phys. 1978;4:587-93.

Tang Y, Shen Q, Wang Y, Lu K, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol. 2011;187:39-44.

Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG. Wound healing after radiation therapy: Review of the literature. Radiation Oncology. 2012;7:162.

Girod DA, McCulloch TM, Tsue TT, Weymuller EA Jr. Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck. 1995;17:7-13.

Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in pre-irradiated soft tissue. J Oral Maxillofac Surg. 2010, 68:2169-78.

Habel DW. Surgical complications in irradiated patients. Arch Otolaryngol. 1965;82(4):382-6.

Marchetta FC, Sako K, Maxwell W. Complications after radical head and neck surgery performed through previously irradiated tissues. Am J Surg. 1967;114(6):835-8.

Griffin TW, Weisberger EC, Laramore GE, Tong D, Blasko JC. Griffin TW, Weisberger EC, Laramore GE, Tong D, Blasko JC. Radiology. 1979;132(1):177-8.

Marcial VA, Hanley JA, Ydrach A, Vallecillo LA. Tolerance of surgery after radical radiotherapy of carcinoma of the oropharynx. Cancer. 1980;46(9):1910-2.

Marcial VA, Gelber R, Kramer S, Snow JB, Davis LW, Vallecillo LA. Does preoperative irradiation increase the rate of surgical complications in carcinoma of the head and neck? A Radiation Therapy Oncology Group Report. Cancer. 1982;49(6):1297-301.

Dormand EL, Banwell PE, Goodacre TE. Radiotherapy and wound healing. Int Wound J. 2005;2:112-27.

Albers-Schonberg. Beitrag zur therapeutischen Verwendung der Roentgenstrahlen in der Behandlung des Lupus. Fortschritte ad Geb d Roentgen. 1897;1:72-5.

Hom DHV, Lee C. Irradiatid Skin and Its Postsurgical Management. In Essential Tissue Healing of the Face and the Neck. Edited by Hom H, Gosain F. 2009:224-38.

Joseph DL, Shumrick DL. Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol. 1973;97(5):381-4.

Powers WE, Ogura JH, Palmer LA. Radiation therapy and wound healing delay. Animals and man.Radiology. 1967;89(1):112-5.

Powers WE, Ogura JH. Preoperative irradiation in head and neck cancer surgery. Arch Otolaryngol. 1965;81:153-60.

Silverstone SM, Goldman JL, Rosin HD. Combined therapy, irradiation and surgery, for advanced cancer of the laryngopharynx. Am J Roentgenol Radium Ther Nucl Med. 1963;90:1023-31.

Moffat FL, Ketcham AS. Breast-conserving surgery and selective adjuvant radiation therapy for stage I and II breast cancer. Semin Surg Oncol. 1992;8(3):172-6.