Impending Airway Collapse Mistaken for Cancer Recurrence: A Case of Delayed Radiation-Induced Hypopharyngeal Necrosis

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Definitive chemoradiation is a cornerstone in the management of locally advanced hypopharyngeal squamous cell carcinoma but is associated with significant delayed toxicities. Post-treatment mucosal injury, necrosis, and fibrosis may mimic tumor recurrence clinically and radiographically, creating diagnostic and management challenges. Severe airway compromise from delayed radiation effects remains uncommon but potentially life-threatening.

We report an older male with stage III hypopharyngeal squamous cell carcinoma diagnosed in 2025 and treated with definitive chemoradiation completed in two months later. Surveillance PET-CT performed three months post-treatment demonstrated persistent metabolic activity at the primary site concerning for residual disease. Approximately five months following completion of therapy, the patient presented with progressive cough, copious secretions, positional dyspnea, and inspiratory stridor concerning for impending airway collapse. He was admitted to the intensive care unit under the hospitalist service for close airway monitoring and required noninvasive ventilatory support and corticosteroid therapy. Laryngoscopy demonstrated bilateral vocal cord immobility with critical airway narrowing. Given the concerning PET findings and clinical deterioration, recurrent malignancy was presumed to be the primary driver of airway compromise.

This case highlights the risk of presuming malignant recurrence based on surveillance imaging and clinical decline alone. Delayed radiation-induced necrosis may closely mimic tumor progression and can precipitate life-threatening airway compromise. Histopathologic confirmation remains essential before establishing prognosis or pursuing hospice-directed care in head and neck cancer survivors.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2028

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