Botulinum toxin in the treatment of post-radiosurgical neck contracture in head and neck cancer: A novel approach

Abstract

Neck pain affects a third of patients following head-and-neck cancer treatment, whether by radiation therapy or surgery. It is a disabling condition and the associated muscle contractures impair cervical motion. Type-A botulinum toxin is an analgesic and muscle relaxant, able to improve patients' quality of life. We here report our experience with botulinum toxin in post-radiosurgical neck contracture. A single-center pilot study was run from January2007 to July2008, respecting the Declaration of Helsinki. All patients in complete remission from head-and-neck cancer with post-radiosurgical neck contracture impairing neck motion were included. Pain and functional impairment were assessed on a neck-function disability scale before and 1month after botulinum toxin injection. Efficacy duration was measured. Complications at the injection site or related to drug diffusion were investigated. Nine consecutive patients (six male, three female; mean age, 61years [range, 52-73years]) were included. In six patients, the sternocleidomastoid muscle was injected and the muscular pedicle of a pectoralis major flap in three. Mean cervical disability score fell significantly from 33 to 23 (P=0.01). There were no complications. Efficacy was seen at a mean 6days, and analgesia and muscle relaxation lasted for a mean 19days. In post-radiosurgical neck contracture, botulinum toxin injection is a simple and easy procedure able to improve neck motion and reduce neck pain in head-and-neck cancer patients. A phase-II prospective study to determine injection sites and dosage should help bear out these preliminary findings.