Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities

Abstract

Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.

Multimodal treatment of atypical transformation of pleomorphic adenoma (PA) of the lacrimal gland into high-grade ductal carcinoma

“…There are several immediate complications caused by radiation such as hearing loss, dermatological-radiation impairments, and late effects such as local bone necrosis areas. In the context of modern treatment scenarios, in many patients the damage caused by radiation is further aggravated by the administration of concurrent systemic cytotoxic agents [11,12].…”

Hydro-dissection of Dorsal Scapular Nerve for Neuropathy Post Radical Neck Dissection and Radiation: A Case Report

“…[ 2 ] Besides, radiation-induced neuropathies of brachial plexus, cranial nerves, optic neuropathies, etc., have also been reported. [ 3 ] Yet, no case has been reported so far involving the DSN following NDs or radiotherapy for head and neck cancers. Although injury to SAN also could produce swinging scapula such as in our case, the fibrotic changes found in the ultrasound as well as the pain in the medial portion of the scapula classically suggest the involvement of DSN.…”

“…The common causes of neuropathy of the dorsal scapular nerve (DSN) are work-related strain, vehicle trauma, or sports injuries. [ 1 ] Although, various nerve injuries or neuropathies either due to neck dissections [ 2 ] or radiotherapy [ 3 ] have been reported in the literature, neuropathy of DSN associated with head and neck malignancy or the sequelae of treatment has not been reported so far. Recently, hydro-dissection of nerve under ultrasound guidance has been receiving more attention in the pain medicine field.…”

An Atypical Presentation of Sinonasal Tract Alveolar Rhabdomyosarcoma in a Young Male Patient Submitted to Multimodality Treatment

“…However, side effects of RT+ occur on the surrounding tissues, such as regional radiodermatitis, skin peeling, itching, skin pigmentation and fibrosis, and alopecia and, in some cases and depending on the size of the irradiated field, damage to hearing has been observed [ 6 , 7 ]. As regards the oral cavity, different degrees of mucositis in different anatomical sites, xerostomia, and hyposalivation, as well as opportunistic infections of candidiasis and herpetic and/or herpetiform lesions, whose etiology could also be associated with QT+, could be associated with RT+ as well [ 8 ].…”

“…Adjuvant therapies have been used to manage the side effects of multimodality therapy in order to decrease pain and general discomfort. Conventional medical management associated with photobiomodulation (laser therapy) and topical applications of corticosteroids have shown satisfactory clinical results in improving local conditions in affected patients [ 8 ].…”