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Inicio Radiología (English Edition) Follow-up in head and neck cancer. What the radiologist must know
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Vol. 62. Issue 1.
Pages 13-27 (January - February 2020)
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Vol. 62. Issue 1.
Pages 13-27 (January - February 2020)
Update in Radiology
Follow-up in head and neck cancer. What the radiologist must know
Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer
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I.M. González-Moreno
Corresponding author
im.gonzalezmoreno@gmail.com

Corresponding author.
, S. Torres del Río, C. Vázquez Olmos
Servicio de Radiodiagnóstico, Hospital General Universitario José M.ª Morales Meseguer, Murcia, Spain
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Table 1. Summary of NI-RADS category descriptors, imaging findings, and clinical-radiological management.
Abstract

The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas, …). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control.

Keywords:
Follow-up
Head and neck neoplasms
Neoplasm recurrence, local
Treatment outcome
Combined modality therapy
Radiation injuries
Surgical flaps
Multimodal imaging
Resumen

El manejo de los pacientes con cáncer de cabeza y cuello implica un tratamiento multidisciplinar con cirugía, radioterapia y quimioterapia. Las pruebas de imagen son cruciales en su seguimiento, sobre todo cuando la recurrencia tumoral no sea clínicamente evidente. Distinguir radiológicamente los cambios postratamiento de una recidiva tumoral constituye un reto debido a la alteración anatómica que suponen las técnicas quirúrgicas y sus reconstrucciones, al tratamiento radioterápico y a las pautas quimioterápicas. El diagnóstico diferencial debe incluir las posibles complicaciones derivadas de la radioterapia (necrosis mucosa, osteorradionecrosis, vasculopatía, radionecrosis cerebral) y de la cirugía (infecciones de la herida, necrosis del colgajo, fístulas, etc.). Un amplio conocimiento de los hallazgos esperables del tratamiento multimodal y sus complicaciones es esencial para un diagnóstico preciso de recurrencia tumoral. Por último, elegir la prueba de imagen adecuada y disponer de un estudio basal postratamiento es igualmente relevante para un control radiológico idóneo.

Palabras clave:
Seguimiento
Neoplasias de cabeza y cuello
Recurrencia neoplásica, local
Resultados del tratamiento
Terapia de modalidad combinada
Lesiones por radiación
Colgajos quirúrgicos
Imagen multimodal

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