Head and Neck Muscle Spasm After Radiotherapy

Daele, Douglas J. Van; Finnegan, Eileen M.; Rodnitzky, Robert L.; Zhen, Weining; McCulloch, Timothy M.; Hoffman, Henry T.

doi:10.1001/archotol.128.8.956

Cited by 39 publications

(10 citation statements)

References 13 publications

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“…Type-A botulinum toxin is an analgesic and a muscle relaxant and has been used to treat pain related to neck muscle spasm and contracture in post-XRT HNC patients. Along with conventional analgesics, future studies should explore Botulinum toxin injection and other therapies as therapeutic options to treat chronic pain in post-XRT HNC patients [37, 38].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Chronic Pain among Head and Neck Cancer Patients Treated with Radiation Therapy: A Retrospective Study

Kallurkar

Kulkarni

Delfino

et al. 2019

Pain Research and Management

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Pain is common among patients with head and neck cancer (HNC). However, there are very limited data on chronic pain among HNC patients treated with radiation therapy (XRT). In this retrospective study, we focused on the characteristics of chronic post-XRT pain in such patients. Post-XRT pain is common among HNC patients; however, we found discrepancy between frequency of treatment and frequency of chronic pain, suggesting poor documentation of pain in the medical records. Among patients who reported to have chronic post-XRT pain, most of them described having severe pain and used descriptors of neuropathic pain. Pharynx was the commonest site of cancer as well as the commonest site of cancer-related chronic pain; squamous cell carcinoma was the most frequent histological pattern, and opioids were used most often to treat such chronic pain. There was a significant association between chronic pain and number of sites of pain, and chronic pain was also associated with use of opioids.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Chronic Pain among Head and Neck Cancer Patients Treated with Radiation Therapy: A Retrospective Study

Kallurkar

Kulkarni

Delfino

et al. 2019

Pain Research and Management

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“…Post-radiotherapy neck muscle spasm among HNC patients began to receive attention about two decades ago, however, to date, only three papers have been published regarding this adverse effect in HNC patients. Van Daele et al first reported the condition in 2002, finding that after RT in the neck area, 9 HNC patients suffered neck muscle spasm, concentrated in the SCM [ 9 ]. Then in 2011, Gelblum et al reported that 14 HNC patients developed severe neck spasm after undergoing IMRT ± chemotherapy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has demonstrated a strong dose-response relationship between neck muscle spasm and the radiation dose received by the SCM of HNC patients [ 9 ]. However, the independent prognostic variables for post-radiotherapy neck muscle spasm remain unclear; moreover, of the few published studies on the topic, none examined patients with NPC [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Patient- and treatment-related risk factors associated with neck muscle spasm in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy

Zhang

Zhou

et al. 2017

BMC Cancer

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BackgroundTo evaluate the incidence of neck muscle spasm in nasopharyngeal carcinoma (NPC) patients that received intensity-modulated radiotherapy (IMRT), and to analyse the patient- and treatment-related risk factors associated with neck muscle spasm.MethodsA sample of 152 IMRT-treated, biopsy-proven, nondisseminated NPC patients were retrospectively analysed. All had documented IMRT treatment plans and had returned for follow-up review at 4 years post-radiotherapy. Spasm of the sternocleidomastoid (SCM) muscle was graded from 0 to 3 (absent to severe) and this grade served as the clinical endpoint. Risk factors were identified using logistic regression analysis.ResultsWithin 4 years of radiotherapy, neck muscle spasm developed in 23.68% of the patients; Grades 0, 1, 2 and 3 were respectively assigned to 83.55, 7.57, 6.58 and 2.30% of assessed SCMs. Multivariate analysis indicated that gender, N stage, V60 (percentage of SCM volume that received >60 Gy) were independent prognostic variables, and that the optimal threshold for using V60 to predict neck muscle spasm was 61.92% (sensitivity = 0.900, specificity = 0.953).ConclusionsGender, N stage and V60 were independent predictive factors for post-radiotherapy neck muscle spasm, and a V60 of ≤61.92% in the SCM was relatively safe.

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“…Animal studies have shown focal loss of capillaries and muscle degeneration 2–4 months after a one-time 2000 rad (20 Gy) treatment. The damage increases collagen and decreases proteoglycans in extracellular matrix leading to disorganized structure and fibrotic tissue formation [ 11 ]. Focal pain is reported in about 20%–30% of patients after radiation therapy of head and neck cancer [ 12 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Incobotulinum Toxin-A Improves Post-Surgical and Post-Radiation Pain in Cancer Patients

Rostami

Mittal

Radmand

et al. 2016

Toxins

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Cancer patients who undergo surgery or radiation can develop persistent focal pain at the site of radiation or surgery. Twelve patients who had surgery or radiation for local cancer and failed at least two analgesic medications for pain control were prospectively enrolled in a research protocol. Patients were injected up to 100 units of incobotulinum toxin A (IncoA) intramuscularly or subcutaneously depending on the type and location of pain (muscle cramp or neuropathic pain). Two patients passed away, one dropped out due to a skin reaction and another patient could not return for the follow up due to his poor general condition. All remaining 8 subjects (Age 31–70, 4 female) demonstrated significant improvement of Visual Analog Scale (VAS) (3 to 9 degrees, average 3.9 degrees) and reported significant satisfaction in Patients’ Global Impression of Change scale (PGIC) (7 out of 8 reported the pain as much improved). Three of the 8 patients reported significant improvement of quality of life.

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Head and Neck Muscle Spasm After Radiotherapy

Abstract: A subset of patients with irradiation-induced cervical muscle spasm benefit from treatment with botulinum toxin A injections. Further study is needed to more clearly define the entity and treatment.

Cited by 39 publications

References 13 publications

Characteristics of Chronic Pain among Head and Neck Cancer Patients Treated with Radiation Therapy: A Retrospective Study

Characteristics of Chronic Pain among Head and Neck Cancer Patients Treated with Radiation Therapy: A Retrospective Study

Patient- and treatment-related risk factors associated with neck muscle spasm in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy

Incobotulinum Toxin-A Improves Post-Surgical and Post-Radiation Pain in Cancer Patients

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