Late Cranial Neuropathy in Survivors of Head and Neck Cancer
Posted: Friday, December 13, 2019
Radiation-induced cranial nerve palsy can occur many years after a patient has finished radiation therapy for head and neck cancer, according to a retrospective study in a single institution. Thomas J. Galloway, MD, of the Fox Chase Cancer Center, Philadelphia, and colleagues emphasized the importance of long-term follow-up in this patient population. The study results were published in Oral Oncology.
“We had always thought that radiation did not damage cranial nerves, and we do not see cranial neuropathy that commonly,” stated Dr. Galloway in a Fox Chase press release. However, the study data indicate that “a small percentage of people do get cranial nerve damage from treatment, but it occurs after a long latency period,” he added.
The retrospective study focused on data from 1,100 patients treated for head and neck cancer between 1990 and 2005 at Fox Chase. A total of 112 patients met the inclusion criteria, with an average follow-up of 12.2 years.
Of the 112 patients, 16 (14%) developed at least one radiation-induced cranial nerve palsy. The average time in developing cranial nerve palsy was 7.7 years, with the majority developing between 5 and 11 years. Cranial nerve XII was the most common site of neuropathy, noted in eight patients; seven patients experienced a deficit in cranial nerve X. Some of the patients with cranial X and XII deficits required a permanent gastrostomy tube. In addition, on univariable analysis, the investigators found four factors were significantly associated with an increased risk in cranial neuropathy: the site of primary disease, postradiation neck dissection, chemotherapy, and radiation dose.
“The main take-home message of this study is that these patients need to be followed for the rest of their lives, if possible,” said Dr. Galloway.
Disclosure: The study authors reported no conflicts of interest.