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Long-term neuromusculoskeletal side effects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy

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Abstract

Aim

In this study, we aimed to evaluate the neuromusculoskeletal late side effects and their impact on the quality of life of patients with nasopharyngeal carcinoma treated with radiochemotherapy.

Patients and methods

Twenty-seven patients were included. The mean follow-up was 61 months (range, 18–111 months). The median external radiotherapy dose applied to the nasopharynx and primary tumor was 70 Gy (range, 61–73 Gy). The mean dose received by the temporomandibular joint in the dose-volume histograms of these patients was 60.7 Gy. The maximal doses of the muscles responsible for cervical motion in different ranges were greater than 60 Gy, and the mean doses were greater than 40 Gy in the muscle groups, except for the extensor muscles.

Results

Two patients had brachial plexus involvement, while 89% of the patients had restriction in flexion and extension movements. Of the patients, 52% had trismus. There was a significant correlation between extension restriction and general heath score and the physical subscale of the quality-of-life questionnaire (p = 0.01). There was also a correlation between trismus and pain killer usage (p = 0.004).

Conclusion

This is the first study to analyze long-term muscle and nerve toxicity and their correlation between doses in nasopharyngeal cancer patients following radiochemotherapy. Despite the advances in radiotherapy techniques, it is necessary to pay attention to the doses of the nerves and muscles for late effects.

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Abbreviations

NPC:

Nasopharyngeal cancer

RT:

Radiotherapy

CT:

Chemotherapy

RIF:

Radiation-induced fibrosis

IMRT:

Intensity-modulated RT

BP:

Brachial plexus

RTOG:

Radiation therapy oncology group

TMJ:

Temporomandibular joint

EMG:

Electromyography

NCSs:

Nerve conduction studies

AANEM:

American Association of Neuromuscular & Electrodiagnostic Medicine

EORTC:

European Organisation for Research and Treatment of Cancer

CTS:

Carpal tunnel syndrome

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Acknowledgement

We thank Miss Arzu Baygül for her support with the statistical analysis. We also thank Miss Nargül Türkmen, the assistant manager, for her support to complete this study.

Funding

This research received no funding.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Radiation Oncology, Kocaeli University, Kocaeli, Turkey

    Aysegul Ucuncu Kefeli

  2. School of Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey

    Canan Sanal-Toprak & Gulseren Akyuz

  3. Marmara University Pendik Education and Research Hospital Radiology Clinic, Istanbul, Turkey

    Ruslan Asedov

  4. Acıbadem Altunizade Hospital Radiation Oncology Clinic, Istanbul, Turkey

    Zeynep Ozen

  5. School of Medicine, Department of Internal Medicine Division of Medical Oncology, Marmara University, Istanbul, Turkey

    Faysal Dane

  6. School of Medicine, Department of Radiation Oncology, Marmara University, Istanbul, Turkey

    Beste M. Atasoy

  7. S.B.-M.Ü. Pendik Egitim ve Arastırma Hastanesi Radyasyon Onkolojisi Klinigi, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 6 Pendik 34899, Istanbul, Turkey

    Beste M. Atasoy

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  1. Aysegul Ucuncu Kefeli
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Contributions

All authors were involved in the conception and design of the study; acquisition, analysis, and interpretation of data; drafting the manuscript and revising it critically for important intellectual content; and providing final approval of the version to be published.

Corresponding author

Correspondence to Beste M. Atasoy.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed with the permission of the Ethics Committee of Marmara University School of Medicine with the study number: 09.2012.0219.

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Informed consent was obtained from all individual participants included in this study.

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Ucuncu Kefeli, A., Sanal-Toprak, C., Asedov, R. et al. Long-term neuromusculoskeletal side effects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy. Eur Arch Otorhinolaryngol 277, 2325–2333 (2020). https://doi.org/10.1007/s00405-020-05932-w

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  • DOI: https://doi.org/10.1007/s00405-020-05932-w

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