Osteoradionecrosis of the Scalp: A Case Series Highlighting Clinical Challenges and Literature Gaps

Abstract Objective Cutaneous carcinoma of the scalp is a common, but underreported, and complications of scalp irradiation remain poorly described. Many patients receive primary or postoperative radiation to the scalp, and complications from treatment are not well described. Calvarial osteoradionecrosis can be difficult to treat, and it is imperative that research be done to learn more about this disease. In this case series, we attempt to define its incidence and identify risk factors for the development of osteoradionecrosis of the calvarium. Study Design Retrospective study. Setting Single tertiary academic medical center. Methods Information, including diagnosis, surgery, radiation dose, past medical history, time to bone exposure, and treatment, was analyzed for all patients undergoing scalp irradiation from 2018 to 2023. Results Forty‐five patients received scalp irradiation for cutaneous head and neck cancer, and 14 developed calvarial osteoradionecrosis. Ten patients had both their original surgery and radiation at our institution, yielding an institutional incidence of 24.4% of calvarial osteoradionecrosis. All patients who developed calvarial osteoradionecrosis originally underwent surgery followed by postoperative radiation, with the median amount of time between surgery and radiation being 42 days (36‐114 days) and a median radiation dose of 57.5 grays in 25 fractions. The average time between completion of radiation therapy and development of osteoradionecrosis was 890 days (2.4 years). All patients were managed conservatively without surgical intervention, hospitalization, or intracranial complications. Conclusion Osteoradionecrosis of the calvarium is an underreported late complication of scalp radiation that can be managed conservatively.