How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?
Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristics such as pain or high white cell counts? What would lead to discussing biopsy with the patient's surgeon?
Answer from: Radiation Oncologist at Academic Institution
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 m...
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