Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Janssen,Stefan; Glanzmann,Christoph; Yousefi,Bita; Loewenich,Karl; Huber,Gerhard; Schmid,Stephan; Studer,Gabriela

doi:10.3892/mco.2015.558

Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Authors:
- Stefan Janssen
- Christoph Glanzmann
- Bita Yousefi
- Karl Loewenich
- Gerhard Huber
- Stephan Schmid
- Gabriela Studer
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Affiliations: Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, 8091 Zurich, Switzerland, Department of Otorhinolaryngology, Bethanien Hospital, 8044 Zurich, Switzerland
Published online on: May 4, 2015 https://doi.org/10.3892/mco.2015.558
Pages: 811-816

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Abstract

Radiation-induced cranial nerve palsy (RICNP) is a severe long-term complication in patients with head and neck cancer following high‑dose radiation therapy (RT). We present the case report of a patient with bilateral RICNP of the hypoglossal and vagus cranial nerves (XII/X) following postoperative RT in the era prior to the introduction of intensity‑modulated RT (IMRT), and an analysis of our IMRT patient cohort at risk including the case of a XII RICNP. A total of 201 patients whose glosso-pharyngeal (IX), X and XII cranial nerves had been exposed to >65 Gy definitive IMRT in our institution between January, 2002 and December, 2012 with or without systemic therapy, were retrospectively identified. A total of 151 patients out of 201 fulfilling the following criteria were included in the analysis: Locoregionally controlled disease, with a follow‑up (FU) of >24 months and >65 Gy exposure of the nerves of interest. So far, one of the assessed 151 IMRT patients at risk exhibited symptoms of RICNP after 6 years. The mean/median FU of the entire cohort was 71/68 months (range, 27‑145). The results were compared with literature reports. In conclusion, RICNP appears to be a rare complication. However, a longer FU and a larger sample size are required to draw reliable conclusions on the incidence of RICNP in the era of IMRT.

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