Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

Inaba, Koji; Nakamura, Satoshi; Okamoto, Hiroyuki; Kashihara, Tairo; Kobayashi, Kazuma; Harada, Ken; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Murakami, Naoya; Ito, Yoshinori; Igaki, Hiroshi; Umemura, Takashi; Itami, Jun

doi:10.1093/jrr/rrv055

Cited by 10 publications

(12 citation statements)

References 8 publications

(9 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…Only a few studies have investigated the development of early-onset DHS following radiation (Table 1) [4,10,11]. Inaba and colleagues compared three patients with DHS after radiotherapy for head and neck cancer to nine patients without DHS [4]. The mean dose to the neck extensor muscles of the three patients with DHS was 58.5 Gy, 42.3 Gy, and 60.9 Gy, while the dose was <50 Gy in all nine patients in the control group.…”

Section: Discussionmentioning

confidence: 99%

“…These authors suggested that early-onset DHS may be due to the magnitude of the radiation dose to the neck extensor muscles, and they recommended that the radiation dose should be <46 Gy. Of the nine previously reported cases of early-onset DHS after radiation, seven were also treated with chemotherapy (Table 1) [4,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Dropped head syndrome (DHS) refers to severe weakness of the neck extensor muscles resulting in the inability to extend the neck with subsequent chin-on-chest deformity [1][2][3][4][5][6]. This condition may result from myriad neuromuscular or extrapyramidal disorders such as amyotrophic lateral sclerosis (ALS), myasthenia gravis, inflammatory myopathy, chronic inflammatory demyelinating polyneuropathy, hypothyroidism, congenital myopathy, and Parkinson's disease [1,2,7], however, may also be rare sequelae of radiotherapy usually for head and neck cancer, in particular, Hodgkin's lymphoma [1,4,6,8]. DHS more commonly develops as a late complication of radiation (up to 30 years post-radiation) [1,2,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…DHS more commonly develops as a late complication of radiation (up to 30 years post-radiation) [1,2,8,9]. Only a few cases have been reported with early-onset DHS after radiation (within a few weeks or months) [4,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

Shields¹,

Iyer²,

Liang³

et al. 2022

Cureus

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Dropped head syndrome (DHS) involves severe weakness of the neck extensor muscles causing the mandible to drop to the chest wall. Isolated neck extensor weakness is a rare complication of radiotherapy. This condition may result within a few weeks or months following radiotherapy (early-onset) or several years after radiotherapy (late-onset), with the latter more commonly encountered. Person-in-the-barrel syndrome is marked by bilateral brachial diplegia, intact cranial nerves, and preserved lower extremity strength. We describe the unique clinical profile of a patient with a six-week history of significant neck and bilateral upper extremity weakness who was diagnosed three months prior to the onset of these symptoms with moderately differentiated squamous cell carcinoma within the base of the tongue (Stage III T2N1M0) and metastasis to the cervical lymph nodes. She underwent concurrent chemotherapy with three cycles of cisplatin (197 mg {100 mg/m 2 } x 197 m 2 ) and hyperfractionated external beam radiation therapy (total dose cGy 7000 cGy in 35 fractions {200 cGy per fraction}). She reported the rapid onset of neck and bilateral upper extremity weakness six weeks following cisplatin termination and four weeks after radiation termination. A cervical MRI suggested myositis of the cervical paraspinal muscles, and electrodiagnostic studies indicated an inflammatory myopathic process involving the cervical paraspinal and shoulder girdle muscles. The patient attained a complete resolution of her symptoms eight months after onset. This case illustrates the rare phenomenon of early-onset DHS and person-in-the-barrel syndrome caused by radiation-induced myositis. Prompt recognition of the symptoms associated with DHS and timely treatment offer the best prognosis for recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

Shields¹,

Iyer²,

Liang³

et al. 2022

Cureus

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Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

Rieken,

Kronziel,

Langer

et al. 2023

J Cancer Res Clin Oncol

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Purpose To prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS. Methods A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy. Results Two hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain. Conclusions A relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk. Implications for cancer survivors Integration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.

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Effects of Head and Neck Cancer Radiotherapy on Cricothyroid Membrane Related Dimensions

Muthukumar,

Khanpara,

Wegner

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

Cited by 10 publications

References 8 publications

Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

Effects of Head and Neck Cancer Radiotherapy on Cricothyroid Membrane Related Dimensions

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