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Ricard D, Durand T, Bompaire F, Tauziède-Espariat A, Psimaras D. Complicanze neurologiche della radioterapia. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Aggarwal P, Zaveri JS, Goepfert RP, Shi Q, Du XL, Swartz M, Lai SY, Fuller CD, Lewin JS, Piller LB, Hutcheson KA. Swallowing-related outcomes associated with late lower cranial neuropathy in long-term oropharyngeal cancer survivors: cross-sectional survey analysis. Head Neck 2019; 41:3880-3894. [PMID: 31441572 DOI: 10.1002/hed.25923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/06/2019] [Accepted: 08/07/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to quantify the association of late lower cranial neuropathy (late LCNP) with swallowing-related quality of life (QOL) and functional status among long-term oropharyngeal cancer (OPC) survivors. METHODS Eight hundred eighty-nine OPC survivors (median survival time: 7 years) who received primary treatment at a single institution between January 2000 and December 2013 completed a cross-sectional survey (56% response rate) that included the MD Anderson Dysphagia Inventory (MDADI) and self-report of functional status. Late LCNP events ≥3 months after cancer therapy were abstracted from medical records. Multivariate models regressed MDADI scores on late LCNP status adjusting for clinical covariates. RESULTS Overall, 4.0% (n = 36) of respondents developed late LCNP with median time to onset of 5.25 years post-treatment. LCNP cases reported significantly worse mean composite MDADI (LCNP: 68.0 vs no LCNP: 80.2; P < .001). Late LCNP independently associated with worse mean composite MDADI (β = -6.7, P = .02; 95% confidence interval [CI], -12.0 to -1.3) as well as all MDADI domains after multivariate adjustment. LCNP cases were more likely to have a feeding tube at time of survey (odds ratio [OR] = 20.5; 95% CI, 8.6-48.9), history of aspiration pneumonia (OR = 23.5; 95% CI, 9.6-57.6), and tracheostomy (OR = 26.9; 95% CI, 6.0-121.7). CONCLUSIONS In this large survey study, OPC survivors with late LCNP reported significantly poorer swallowing-related QOL and had significantly higher likelihood of poor functional status. Further efforts are necessary to optimize swallowing outcomes to improve QOL in this subgroup of survivors.
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Affiliation(s)
- Puja Aggarwal
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,University of Texas School of Public Health, Houston, Texas
| | - Jhankruti S Zaveri
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Xianglin L Du
- University of Texas School of Public Health, Houston, Texas
| | - Michael Swartz
- University of Texas School of Public Health, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Linda B Piller
- University of Texas School of Public Health, Houston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Hutcheson KA, Yuk M, Hubbard R, Gunn GB, Fuller CD, Lai SY, Lin H, Garden AS, Rosenthal DI, Hanna EY, Kies MS, Lewin JS. Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review. Head Neck 2017; 39:1516-1523. [PMID: 28452175 DOI: 10.1002/hed.24789] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
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.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maggie Yuk
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel Hubbard
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill S Kies
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Benoliel R, Epstein J, Eliav E, Jurevic R, Elad S. Orofacial Pain in Cancer: Part I—Mechanisms. J Dent Res 2016; 86:491-505. [PMID: 17525348 DOI: 10.1177/154405910708600604] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The mechanisms involved, and possible treatment targets, in orofacial pain due to cancer are poorly understood. The aim of the first of this two-part series is to review the involved pathophysiological mechanisms and explore their possible roles in the orofacial region. However, there is a lack of relevant research in the trigeminal region, and we have therefore applied data accumulated from experiments on cancer pain mechanisms in rodent spinal models. In the second part, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. In the present article, we provide a brief outline of trigeminal functional neuro-anatomy and pain-modulatory pathways. Tissue destruction by invasive tumors (or metastases) induces inflammation and nerve damage, with attendant acute pain. In some cases, chronic pain, involving inflammatory and neuropathic mechanisms, may ensue. Distant, painful effects of tumors include paraneoplastic neuropathic syndromes and effects secondary to the release of factors by the tumor (growth factors, cytokines, and enzymes). Additionally, pain is frequent in cancer management protocols (surgery, chemotherapy, and radiotherapy). Understanding the mechanisms involved in cancer-related orofacial pain will enhance patient management.
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Affiliation(s)
- R Benoliel
- Department of Oral Medicine, The Hebrew University, Hadassah Faculty of Dental Medicine, PO Box 12272, Jerusalem 91120, Israel.
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Ku PKM, Vlantis AC, Leung SF, Lee KYS, Cheung DMC, Abdullah VJ, van Hasselt A, Tong MCF. Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma. Laryngoscope 2009; 120:223-8. [DOI: 10.1002/lary.20701] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, Dutta S, Midyett A, Barloon J, Sallah S. Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2005; 61:772-8. [PMID: 15708256 DOI: 10.1016/j.ijrobp.2004.06.017] [Citation(s) in RCA: 236] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Revised: 06/08/2004] [Accepted: 06/25/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the quality of life (QOL) associated with dysphagia after head-and-neck cancer treatment. METHODS AND MATERIALS Of a total population of 104, a retrospective analysis of 73 patients who complained of dysphagia after primary radiotherapy (RT), chemoradiotherapy, and postoperative RT for head-and-neck malignancies were evaluated. All patients underwent a modified barium swallow examination to assess the severity of dysphagia, graded on a scale of 1-7. QOL was evaluated by the University of Washington (UW) and Hospital Anxiety and Depression questionnaires. The QOL scores obtained were compared with those from the 31 patients who were free of dysphagia after treatment. The QOL scores were also graded according to the dysphagia severity. RESULTS The UW and Hospital Anxiety and Depression scores were reduced and elevated, respectively, in the dysphagia group compared with the no dysphagia group (p = 0.0005). The UW scores were also substantially lower among patients with moderate-to-severe (Grade 4-7) compared with no or mild (Grade 2-3) dysphagia (p = 0.0005). The corresponding Hospital Anxiety (p = 0.005) and Depression (p = 0.0001) scores were also greater for the moderate-to-severe group. The UW QOL subscale scores showed a statistically significant decrease for swallowing (p = 0.00005), speech (p = 0.0005), recreation/entertainment (p = 0.0005), disfigurement (p = 0.0006), activity (p = 0.005), eating (p = 0.002), shoulder disability (p = 0.006), and pain (p = 0.004). CONCLUSION Dysphagia is a significant morbidity of head-and-neck cancer treatment, and the severity of dysphagia correlated with a compromised QOL, anxiety, and depression. Patients with moderate-to-severe dysphagia require a team approach involving nutritional support, physical therapy, speech rehabilitation, pain management, and psychological counseling.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, and VA North Texas Health Care System, S. Lancaster Road, Dallas, TX 75216, USA.
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Yeung PLC, Chiu TTW, Leung ASL. Use of modified Northwick Park Neck Pain Questionnaire in patients with postirradiation neck disability: Validation study. Head Neck 2004; 26:1031-7. [PMID: 15515155 DOI: 10.1002/hed.20102] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No available measure exists for postirradiation neck disability. Adoption of the Chinese Northwick Park Neck Pain Questionnaire (NPQ) for patients with postirradiation neck disability was examined in this study. METHODS Eight physiotherapists and five patients were invited to test the validity of the content. Forty-three patients with neck disability were recruited to evaluate test-retest reliability and internal consistency. The level of neck discomfort, range of neck motion and maximal isometric neck muscle strength, and SF-36 health score were measured for construct validity testing. RESULTS The questionnaire had good content validity, a high degree of test-retest reliability, internal consistency (intraclass correlation coefficient [ICC], 0.94; Cronbach's alpha, 0.88), and good construct validity. NPQ correlated significantly with most of the subscores of SF-36 (r(s), -0.43 to - 0.71) and numeric rating scale (r(s) = 0.69). CONCLUSION The modified Chinese NPQ was found to be reliable and valid for the evaluation of postirradiation neck disability.
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Affiliation(s)
- Polina L C Yeung
- Department of Physiotherapy, Prince of Wales Hospital, Shatin, Hong Kong
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Mizobuchi K, Kincaid J. Accessory neuropathy after high-dose radiation therapy for tongue-base carcinoma. Muscle Nerve 2003; 28:650-1. [PMID: 14571473 DOI: 10.1002/mus.10456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Aprile I, Padua L, Caliandro P, Evoli A, Ausili E, Sabatelli M, Pitocco D, Tonali P. Multinevritis of cranial nerves following inhalation of toxins. Neurol Res 2003; 25:208-10. [PMID: 12635524 DOI: 10.1179/016164103101201210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cranial multineuropathy is an uncommon occurrence. We observed two cases of multinevritis of the cranial nerves which had many features in common: acute onset after toxic inhalation, occurrence of neuroparaxic block, and rapid resolution after corticosteroid therapy. We believe physicians should be aware that multinevritis of the cranial nerves may be related to acute exposure to toxic substances. Missing this diagnosis could lead to a delay in therapy.
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Affiliation(s)
- Irene Aprile
- Institute of Neurology, Don C. Gnocchi Foundation, Rome, Italy.
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Abstract
This article reviews the current knowledge with regard to neurotoxicity of conventional radiation, including recent understanding of the pathophysiology, molecular biology, diagnostic evaluation and clinical presentations, as well as proposed treatment modalities and possible protective agents.
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Affiliation(s)
- P New
- Dept. of Medicine/Neurology, University of Texas Health Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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