Unilateral Cervical Polyneuropathies following Concurrent Bortezomib, Cetuximab, and Radiotherapy for Head and Neck Cancer.

Alhasan Elghouche,Carter Van Waes,Yewen Qin,Tom Shokri,Susannah Wargo,Deborah Citrin

doi:10.1155/2016/2313714

Abstract

We report a constellation of cervical polyneuropathies in a patient treated with concurrent bortezomib, cetuximab, and cisplatin alongside intensity modulated radiotherapy for carcinoma of the tonsil with neck metastasis. The described deficits include brachial plexopathy, cervical sensory neuropathy, and oculosympathetic, recurrent laryngeal, and phrenic nerve palsies within the ipsilateral radiation field. Radiation neuropathy involving the brachial plexus is typically associated with treatment of breast or lung cancer; however, increased awareness of this entity in the context of investigational agents with potential neuropathic effects in head and neck cancer has recently emerged. With this report, we highlight radiation neuropathy in the setting of investigational therapy for head and neck cancer, particularly since these sequelae may present years after therapy and entail significant and often irreversible morbidity.

Highlights

We report the case of a patient with head and neck cancer (HNC) who developed multiple distinct neuropathies following participation in a clinical trial in which she received concurrent bortezomib, cetuximab, cisplatin, and radiotherapy
Their study showed that the use of concurrent chemotherapy increased the risk of developing neuropathy and that delivery of higher doses of radiation to the brachial plexus was strongly associated with subsequent symptom development
The above case report demonstrates that concurrent administration of bortezomib in conjunction with cetuximab and radiotherapy is associated with an array of distinct cervical neuropathies

Summary

Introduction

We report the case of a patient with head and neck cancer (HNC) who developed multiple distinct neuropathies following participation in a clinical trial in which she received concurrent bortezomib, cetuximab, cisplatin, and radiotherapy. The patient’s neuropathies include brachial plexopathy, cervical allodynia, and oculosympathetic, recurrent laryngeal, and phrenic nerve palsies. This is the first case to describe such an array of deficits in the context of this particular treatment regimen. Radiation-induced brachial plexopathy (RIBP) has long been recognized as a potential toxicity of radiation therapy in patients with carcinoma of the breast or lung. There is emerging recognition of the potential for RIBP in patients treated for HNC

Case Presentation

Discussion

Conclusion