Laryngeal radionecrosis and hyperbaric oxygen therapy: Report of 18 cases and review of the literature

Laryngeal radionecrosis is a difficult late complication of radiotherapy. I t is associated with hoarseness, edema, pain, weight loss, and upper airway obstruction. The medical treatment options are Limited, and in severe case s. the patient may require tracheostomy or laryngectomy. We report clinical results in 18 patients treated with adjunctive hyperbaric oxygen (HBO) the rapy for severe radionecrosis of the larynx. Of these 18 patients, 2 had gr ade 3 and 16 had grade 1 radionecrossi. The patients received a mean number of 41 HBO treatments (range, 6 to 80) at 2 atmospheres absolute for 2 hour s, twice a day, 6 days a week week. Thirteen patients (72.2%) had a major i mprovement after HBO therapy, and none of them required total laryngectomy. All patients preserved their voice and deglutition in good or normal condi tion. Five patients (27.8%) failed to have a good response to HBO and under went total laryngectomy. One of these patients had local recurrence of his cancer 4 months later, and the other 3 had significant concurrent medical p roblems. The remaining patient received only 6 HBO treatments because of em ergency heart surgery. These encouraging results are comparable to those of smaller previous studies suggesting that HBO has a beneficial effect in th e management of advanced laryngeal radionecrosis.