How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?

This is a difficult clinical situation. I find physical exams including laryngoscopy to be of most use. If there are sharp borders and ulcers are soft with signs of infection, I will more likely suspect necrosis with super-infection. In this case, I will try antibiotics, antifungal, and antiseptic mouthwash for 2-3 weeks. Patients in this situation would be expected to improve, but perhaps not completely resolve in their symptoms over this time period.

Rolled borders with induration, especially...