Abstract
Background Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues
to be a rare, devastating, and hard to treat complication of radiotherapy. We present
three cases of anterior skull base ORN in a cohort treated with intensity-modulated
radiation therapy (IMRT).
Case Series Three patients developed anterior skull base ORN after receiving at least one round
of IMRT. ORN was diagnosed through either nasal endoscopy or imaging findings. The
first was a 59-year-old woman with a sinonasal squamous cell carcinoma. Her chemoradiation
history was notable for reirradiation and a high dose of radiation (143.3 Gy). The
second was a 55-year-old man with recurrent nasopharyngeal carcinoma, whose history
was notable for a high dose of radiation (∼140 Gy) and for being reirradiated. The
final patient was a 37-year-old woman with an unremarkable history who received radiotherapy
(65.0 Gy) for an esthesioneuroblastoma. One patient was asymptomatic and did not receive
ORN-specific therapy. The other two were treated with a combination of medical and
surgical intervention with successful short-term outcomes (no evidence of infection).
Conclusion Anterior skull base ORN can be treated through conservative and surgical means to
achieve successful short-term outcomes. Further investigation of long-term outcomes
is warranted.
Keywords
osteoradionecrosis - skull base - sinonasal tumor - nasopharyngeal tumor - radiation
therapy
