Soft tissue necrosis after radiotherapy for head and neck cancer

A 60-year-old man with cT2N0M0 hypopharyngeal squamous cell carcinoma received definitive chemoradiotherapy. FDG PETCT at 4 weeks showed complete metabolic response at primary site (Figure 1). At 6 months, contrasted CT showed no evidence of disease with soft tissue air indicating radiation necrosis and ulceration (Figure 2). The patient had symptom of dysphagia. Laryngoscopy and esophagogastroduodenoscopy showed inflammation without other severe findings. He had conservative care as a treatment option. At 12 months, contrasted CT showed improved nonenhancing ulceration without disease progression (Figure 3).