Late radiation‐associated dysphagia with lower cranial neuropathy in long‐term oropharyngeal cancer survivors: Video case reports

Abstract

Late-RAD with lower cranial neuropathies resulted in profound and persistent functional impairment. Rarely reported, late radiation-associated lower cranial neuropathies may be a major contributor to new-onset or progressive dysphagia in long-term oropharyngeal cancer survivors.

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

“…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.…”

“…The potential for radiation‐associated LCNP in non‐NPC head and neck cancer survivors has rarely been examined in published reports. Yet, with exceptional numbers of oropharyngeal cancer survivors achieving long‐term disease control, recent case reports highlight the potential for de novo LCNP as a previously unexpected late effect of even modern conformal intensity‐modulated radiotherapy (IMRT) for oropharyngeal cancer . In this report, we examine incidence, latency, and patterns of delayed LCNP after oropharyngeal IMRT with particular interest in implications on long‐term swallowing function.…”

Optimizing Respiratory-Swallowing Coordination in Patients With Oropharyngeal Head and Neck Cancer

“…Relative to pre-RST values, patients participating in one month follow-up (n = 15) demonstrated stability in the learned optimal RST phase pattern, PAS scores, and MBSImP scores observed during post-RST MBSS. Further, MDADI scores also significantly increased after RST, although this did not reach the clinical relevant difference of a 10-point change (Hutcheson et al, 2015; Table 1). These findings suggest that patients with OP HNC and refractory dysphagia could be trained successfully to produce an optimal respiratory-swallow phase pattern after completion of a structured training protocol (RST) and that there were positive effects on mechanisms of bolus clearance and airway protection during liquid swallowing.…”

“…Unlike many other cancers, the incidence of OP HNC is moving in the wrong direction —an increase of 1.3% from 2007 to 2011 likely related to tumors incited by the human papilloma virus (HPV-positive; American Cancer Society, 2015; Gillison, Chaturvedi, Anderson, & Fakhry, 2015). Swallowing impairment (dysphagia) represents the highest functional morbidity in OP HNC treated either with surgical approaches followed by radiation or with more recent organ-preservation protocols, including combined chemotherapy and radiation (Gillespie, Brodsky, Day, & MartinHarris, 2004; Gillespie et al, 2005; Hutcheson, Yuk, Holsinger, Gunn, & Lewin, 2015; Lazarus et al, 2000). Swallowing impairments remain chronic, are often resistant to traditional swallowing therapy, and have devastating consequences on health and well-being.…”

Severe sleep disordered breathing in head and neck cancer survivor

“…Patients may present with significant OSA symptoms prior to diagnosis of the tumour, and changes in the upper airway after definitive treatment may be related to architectural distortion or alteration in neurosensory feedback 4. Radiation neuropathy is a well-described complication of radiation therapy that may manifest years after therapy is completed, and it may result in dysphagia associated with lower cranial neuropathies with subsequent significant and persistent impairment 5. Airway patency during sleep is primarily mediated by the genioglossus muscle which is innervated by the hypoglossal nerve 4.…”