Bilateral Vocal Cord Paralysis following Radiation Therapy for Nasopharyngeal Carcinoma

Chaudhry, M. R.; Akhtar, Saad

doi:10.1159/000276707

Cited by 15 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Subjects included 97.1% (2694/2775) with NPC, 2.3% (63/2775) with oropharyngeal cancer, 0.2% (5/2775) with hypopharyngeal cancer, 0.1% (5/2775) with laryngeal cancer, 0.1% (3/2775) with oral cavity cancer, and 0.2% (5/2775) with other sites of head and neck cancer. Radiation delivery varied among the patients examined in this literature review, with the majority of patients receiving a total dose around 70 Gy, often with a parapharyngeal boost, and chemoradiotherapy . Incidence rates of radiation‐associated LCNP were reported in 9 retrospective cohorts comprising 2565 patients with NPC and 12 patients with non‐NPC sites of head and neck cancer.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Delayed lower cranial neuropathy after oropharyngeal intensity‐modulated radiotherapy: A cohort analysis and literature review

et al. 2017

View full text Add to dashboard Cite

Background To examine swallowing-related lower cranial nerve palsy (LCNP) in oropharyngeal cancer (OPC) survivors after intensity modulated radiotherapy (IMRT). Methods Patients treated with definitive IMRT (66–72 Gy) were pooled from trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre- and 6-, 12-, and 24-months post-IMRT. Time-to-event and incidence of LCNP was estimated with competing risk methods. Literature review (1977–2015) summarized published LCNP outcomes. Results Three of 59 OPC survivors with a minimum 2-year follow-up developed hypoglossal palsy ipsilateral to the index tumor (median latency: 6.7 years, range: 4.6–7.6). At a median of 5.7 years, cumulative incidence of LCNP was 5%. LCNP preceded progressive dysphagia in all cases. Published studies found median incidence of radiation-associated LCNP was 10.5% after NPC, but no OPC-specific estimate. Conclusions While uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long-term functional surveillance in OPC survivorship.

show abstract

Section: Resultsmentioning

confidence: 99%

“…The upper limit was reported at 34 years, and the lower limit at 1 year . Case reports and case series examining radiation‐associated LCNP are summarized in Supporting Information Tables S1 and S2 . Incidence reports from cohort studies and latency data are summarized in Table and Supporting Information Tables S1 and S2, respectively.…”

Section: Resultsmentioning

confidence: 99%

Delayed lower cranial neuropathy after oropharyngeal intensity‐modulated radiotherapy: A cohort analysis and literature review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Radiation therapy (RT) is the main treatment of NPC in early and late stages; its efficacy can be improved by the association with concurrent or adjuvant chemotherapy schemes (Airoldi et al 2009). Late toxicities due to these treatments, such as xerostomy, auditory impairment, and tissue fibrosis, are not uncommon (Takimoto et al 1991;Lee et al 1992;Chaudhry and Akhtar 1995;Stern et al 1995).…”

Section: Introductionmentioning

confidence: 99%

Late Sensorial Alterations in Different Radiotherapy Techniques for Nasopharyngeal Cancer

et al. 2015

View full text Add to dashboard Cite

Intensity-modulated radiation therapy (IMRT) for nasopharyngeal cancer (NPC) allowed a better distribution of the dose to the tumor volume, sparing surrounding structures. Aim of the study is the objective evaluation of olfactory and gustatory impairments in patients who underwent chemo-radiotherapy for NPC. Correlation between smell and taste alterations, xerostomy, and radiation technique was investigated. Thirty healthy subjects and 30 patients treated with chemo-radiation therapy for NPC, with at least a 2-years follow-up period, were evaluated. All subjects underwent symptoms evaluation, endoscopic fiber optic nasal examination, taste strips, Sniffin' sticks tests, Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring system. Patients were divided in 2 groups: 2-dimensional radiotherapy/conformal 3-dimensional radiotherapy and IMRT. A higher percentage of rhinorrhea, nasal obstruction, xerostomy, hyposmia, hypogeusia, mucosal hyperemia, and presence of nasopharyngeal secretions was found in irradiated subjects (P < 0.05). Concerning olfactory and gustatory scores, we demonstrated a statistically significant difference between healthy subjects and irradiated patients (P < 0.05), with lower gustatory total score in IMRT group (P < 0.01). In conclusion, chemo-radiotherapy for NPC induces long-term smell and taste impairments, which can compromise quality of life. Although based on small samples, it is also important to consider that IMRT can induce higher taste dysfunction compared with traditional techniques.

show abstract

“…6 Apart from that study, fewer than 40 patients with NPC who developed conventional radiation therapy-induced cranial nerve palsy have been reported in the English literature since 1966 (see Table 1). [5][6][7][8][9][10][11][12][13][14][15] Cranial neuropathy is of particular practical interest in terms of making a differential diagnosis, because it is also a common presenting manifestation in patients with NPC. Victims of cranial neuropathy suffer from various distressing disabilities; however, treatment for these patients has not been addressed in previous reports.…”

mentioning

confidence: 99%

Radiation‐related cranial nerve palsy in patients with nasopharyngeal carcinoma

Lin

Jen

Lin

2002

Cancer

145

104

View full text Add to dashboard Cite

BACKGROUNDCranial nerve palsy is a rare complication after patients with nasopharyngeal carcinoma (NPC) receive radiotherapy using a technique that delivers 180–200 centigrays (cGy) per day. Cranial neuropathy is of particular clinical interest in terms of making a differential diagnosis, because it is also a common presenting manifestation in patients with NPC. Cranial neuropathy may lead to distressing signs and symptoms in these patients, and their treatment has not been addressed in previous reports. This article presents the authors' experience with radiotherapy‐related cranial nerve palsy in patients with NPC.METHODSNineteen patients were diagnosed with radiation‐related neuropathy. Patients with recurrent tumors or with a suspicion of persistent or recurrent tumors were excluded. Most patients were treated using 180 cGy or 200 cGy per fraction per day. The total dose was 7000–13,000 cGy to the nasopharynx and 5000–9000 cGy to the neck. Unilateral vocal cord paralysis alone and hearing loss were not included in the analysis.RESULTSThere were 15 male patients and 4 female patients. The latency before palsy occurred was 12–240 months. Single nerve palsy developed in four patients, including two patients with hypoglossal palsy and two patients with recurrent laryngeal palsy. Two patients had three nerve palsies each. The other 13 patients presented with 2 nerve palsies each. Vagus and hypoglossal palsy appeared to be a frequent combination and occurred in 11 patients. Overall, there were 17 patients with hypoglossal palsy (7 bilateral, 8 left‐sided, and 2 right‐sided), 11 patients with vagus palsy (2 bilateral, 7 left‐sided, and 2 right‐sided), 6 patients with recurrent laryngeal nerve palsy (5 bilateral), and 2 patients with accessory palsies (all bilateral). Marked neck fibrosis was present in 12 patients. Patients who had vocal cord paralysis suffered from easy choking and hoarseness. Severe respiratory difficulty occurred in two patients who had bilateral vocal cord palsy. Surgical procedures included laryngoplasty, tracheostomy, and gastrostomy. Quality of life improved considerably after patients underwent surgery.CONCLUSIONSRadiotherapy‐related cranial nerve palsy may occur in patients with NPC after they receive conventional radiotherapy. Hypoglossal nerve palsy was found the most frequently in this series, followed by vagus nerve palsy and recurrent laryngeal nerve palsy. Neck fibrosis and the course of the three nerves through the neck may be important risk factors for the development of palsy. The diagnosis must be made only after the possibilities of tumor‐induced palsy and idiopathic palsy are excluded. Surgery is helpful in improving the quality of life in many patients. Cancer 2002;95:404–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10668

show abstract

Bilateral Vocal Cord Paralysis following Radiation Therapy for Nasopharyngeal Carcinoma

Cited by 15 publications

References 5 publications

Delayed lower cranial neuropathy after oropharyngeal intensity‐modulated radiotherapy: A cohort analysis and literature review

Delayed lower cranial neuropathy after oropharyngeal intensity‐modulated radiotherapy: A cohort analysis and literature review

Late Sensorial Alterations in Different Radiotherapy Techniques for Nasopharyngeal Cancer

Radiation‐related cranial nerve palsy in patients with nasopharyngeal carcinoma

Contact Info

Product

Resources

About