Complications in the treatment of oropharyngeal carcinoma in patients with systemic sclerosis: A case report

Abstract

Systemic sclerosis is a chronic, progressive disease with an extremely poor prognosis. The incidence of malignant tumors in patients with systemic sclerosis is increased when compared with that of the general population. In certain malignancies, systemic sclerosis presents as a paraneoplastic process. The symptoms of sclerosis in the organs of the head and neck often overlap with symptoms of malignant diseases, which may increase the difficulty of a differential diagnosis. Additionally, the presence of sclerosis may complicate standard examination procedures, due to poor access to the oral cavity and oropharynx. When considering treatment options, it is important to evaluate the surgical and oncological risks to soft tissues of the head and neck with regard to both diseases, as well as the relatively poor prognosis for systemic sclerosis and oropharyngeal cancer. The low incidence of patients with systemic sclerosis and oropharyngeal carcinoma together presents a clear case for a casuistic approach. Based upon our own experience, we can attest to the difficulty of treating such patients. However, we have no evidence to indicate that these patients have reduced tolerance to surgical treatments. The current study presents the case of a 47-year-old female with systemic sclerosis, who was diagnosed with oropharyngeal carcinoma. The patient initially tolerated radiotherapy treatment well, however post-radiotherapy complications occurred. Despite many enigmatic indications to the contrary, it appears that the complications in this instance may be due to late toxicity from radiotherapy.

The spectrum of orofacial manifestations in systemic sclerosis: a challenging management

“…A nationwide population study also revealed increased SIR for cancer of the oral cavity and pharynx (SIR 3.67 [95% CI 1.83–6.56]) (Kuo et al , ). Diagnosis of oral cancer is particularly challenging in SSc patients as the symptoms of sclerosis can potentially overshadow certain manifestations of malignant diseases and as microstomia may limit access to the oral cavity (Čoček et al , ).…”

Effects of Radiotherapy for Malignancy in Systemic Sclerosis: A Systematic Review

“…Eleven of 26 studies reported SSc outcomes following radiotherapy encompassing 41 patients (33.8%) of the total patients included in this study 12,14,15,19,24,[35][36][37][38][39][40] .…”

“…Fourteen case reports and series included a total of 21 patients. Only 4 patients developed severe acute adverse events, while 9 patients developed non-severe adverse events, and 10 did not develop any adverse effects 12,[14][15][16]32,[35][36][37][38][40][41][42]44,45 . Table 2.…”

“…Late Reactions. Late adverse effects were reported in 25 articles which included 95 patients 12,[14][15][16][18][19][20][21][22][23]25,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] . Fourteen case reports and series had a total of 23 patients.…”

“…Ten patients developed severe late adverse effects (grades 3 and 4), while 15 patients developed non-severe late adverse effects (grades 1 and 2), and 6 did not develop late adverse effects 12,[14][15][16]32,[35][36][37][38][39][40][41][42][43][44][45] . Table 4.…”