Raynaud’s phenomenon after radical radiotherapy for tumours of the head and neck

Abstract

Endothelial cell injury is implicated in the development of radiation induced tissue damage and may also be involved in the pathophysiology of secondary Raynaud’s phenomenon. Two patients are presented in whom the typical symptoms and signs of Raynaud’s phenomenon developed as a late complication of radical radiotherapy. One had Raynaud’s of the tongue and one of the lip. Both patients had a prior history of primary Raynaud’s phenomenon and in each case the symptoms were repeatedly precipitated by sudden cold exposure. The possible pathogenesis of radiation induced Raynaud’s phenomenon in the head and neck region is discussed.

Raynaud's of the tongue following chemoradiation for squamous cell carcinoma of the oropharynx

“…An association among radiation, chemotherapy and Raynaud's has been reported. In patients with pre-existing primary Raynaud's of the digits, developing Raynaud's of the tongue and lips following radiation alone for oropharyngeal and lip cancer was first reported by Westbury et al (6). This group hypothesized that radiation-induced Raynaud's is most likely due to late injury caused to the capillaries and vasculature, with the primary target being endothelium.…”

Lingual Raynaud’s Phenomenon after Surgical and Radiotherapeutic Intervention for Oral Squamous Cell Carcinoma

“…There have been at least 22 cases of lingual involvement reported in the literature, usually associated with systemic sclerosis, Sjögren's syndrome, or other connective tissue disorders [3][4][5][6][7][8]. Of the lingual Raynaud's cases found in the literature, four were identified without preexisting connective tissue disease all occurring after the use of radiotherapy for head and neck squamous cell carcinomas [2,[9][10][11]. In three cases, there was no history of Raynaud's disease affecting the digits and in all cases, radiotherapy had occurred between 18 and 54 months prior to the onset of symptoms.…”

“…Some of the vascular causes include endothelial cell damage, disparate vasoactive substance production, intravascular narrowing, and increasing vasoconstriction [1]. Once exposed to cold, these factors increase the body's natural vasoconstrictive response leading to the classical pale skin of affected areas [1,2].…”

Paraneoplastic Raynaud's Phenomenon—Good Palliation After a Multidisciplinary Approach

“…Raynaud's phenomenon also has been reported as a side effect of biological agents (e.g., interferon) 11 and, rarely, radiotherapy treatment. 12 The initial clinical features of Raynaud's phenomenon represent vasoconstriction of the digital arteries, precapillary arterioles, and cutaneous arteriovenous shunts, and the subsequent clinical features (rubor during rewarming) represent a reactive vasodilatation of these blood vessels. 2 The pathophysiology of Raynaud's phenomenon is not completely understood, but some of the factors involved include increased vasoconstriction, decreased vasodilatation, structural abnormality of small and large vessels, and coagulopathy.…”