Abstract
A case of recurrent nasopharyngeal cancer with osteonecrosis of clivus along with cranial nerve palsy after re-irradiation with a fatal outcome is presented. A 33-year-old female is presented with palpable bilateral enlarged lymph nodes. A mass in the endoscopy of the nasopharynx was biopsied. Histological investigation of the biopsy specimens showed non-keratinized differentiated squamous cell carcinoma. According to the American Joint Committee on Cancer 8th edition, her cancer was T1N2M0 Stage 3. Radiotherapy was delivered after the induction chemotherapy. After 4 years, she had a recurrence and 60 Gy re-irradiation in 30 fractions was delivered after 8 months from recurrence. Six months from re-irradiation; first, bulbar palsy was observed in our patient, magnetic resonance imaging revealed radiotherapy-related osteonecrosis and platybasia due to anterior compression of the cervicomedullary junction. Re-irradiation local control rates are increasing with the advancements of new radiation techniques. As the survival of re-irradiated patients increases, late complications can be fatal.
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