Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction

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ORIGINAL ARTICLE

Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction Masae Yamazaki1 · Taiki Suzuki1,2   · Chiho Hiraga1 · Yoshifumi Yoshida3 · Akira Baba4 · Hirokazu Saitou1,2 · Satoru Ogane2 · Takako Fujii5 · Masayuki Takano6 · Akira Katakura7 · Ichiro Tanaka5 · Takeshi Nomura1,2 · Nobuo Takano2 Received: 29 September 2020 / Accepted: 22 October 2020 © Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2020

Abstract Objective  The purpose of this study was to evaluate the effect of postoperative radiotherapy (RT) on temporal volume changes with a cutaneous free flap (CF) and a myocutaneous free flap (MCF). Methods  The subjects were 24 men and 11 women (mean age, 50.5 ± 15.5 years) with tongue or floor of mouth cancer. Twenty-seven cases of CF and eight cases of MCF were selected. The flap volume change of the reconstructed tongue was calculated using computed tomography (CT) images taken immediately and at one year postoperatively using the DICOM image processing software OsiriX®. Results  The reduction rate in flap volume at one year postoperatively was 82.0 ± 15% in CF without RT, 70.3 ± 26.1% in CF with RT, 88.5 ± 14.7% in MCF without RT, and 99.5 ± 16% in MCF with RT. The MCF volume was significantly higher compared to the CF volume. Although postoperative RT reduced the CF volume by 30%, there was only a slight reduction in the MCF volume. Conclusions  We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. In this study, the effect of RT on volume reduction was different between the CF and MCF. Keywords  Free flap reconstruction · OsiriX® · Tongue cancer

Introduction In recent years, organ-conserving therapy has been established because of advances in chemotherapy [1]. However, surgical resection remains the standard treatment strategy * Taiki Suzuki [email protected] 1



Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5‑11‑13, Sugano, Ichikawa‑shi, Chiba 272‑8513, Japan

2



Oral Cancer Center, Tokyo Dental College, 5‑11‑13, Sugano, Ichikawa‑shi, Chiba 272‑8513, Japan

3

Department of Oral Medicine, Hospital Dentistry, Tokyo Dental College, 5‑11‑13, Sugano, Ichikawa‑shi, Chiba 272‑8513, Japan

4

Department of Radiology, The Jikei University School of Medicine and University Hospital, 3‑25‑8, Nishi‑Shimbashi, Minato‑ku, Tokyo 1058461, Japan





for resectable oral cancer [2]. In the radical treatment of advanced-stage cases, organ loss due to radical resection becomes extensive, causing postoperative dysfunction. Therefore, various reconstructive methods using free flaps have been investigated [3]. 5



Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5‑11‑13, Sugano, Ichikawa‑shi, Chiba 272‑8513, Japan

6



Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2‑9‑18, Kanda‑Misakicho, Chiyoda‑ku, Tokyo 101‑006