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Head Neck. 2017 Aug;39(8):1516-1523. doi: 10.1002/hed.24789. Epub 2017 Apr 28.

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

Author information

1
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Abstract

BACKGROUND:

The purpose of this study was 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 institutional trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre-IMRT, 6 months post-IMRT, 12 months post-IMRT, 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 oropharyngeal cancer 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 years). 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 cancer-specific estimate.

CONCLUSION:

Although uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long-term functional surveillance in OPC survivorship.

KEYWORDS:

cranial neuropathy; dysphagia; hypoglossal nerve; oropharyngeal cancer; radiotherapy

PMID:
28452175
PMCID:
PMC5511776
DOI:
10.1002/hed.24789
[Indexed for MEDLINE]
Free PMC Article

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