Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

Abstract

Recurrent syncope as a complication of recurrent neck malignancy is an uncommon but well documented association. The syncope is presumed to occur when a tumor mass invades the baroreceptor within the carotid sinus or when it disrupts the afferent nerve fibers of the glossopharyngeal nerve. A 59-year-old man presented with recurrent syncope and headache. He had a wide local excision including tonsillectomy and modified left radical neck dissection for tonsilar cancer 4 years ago. A computed tomography scan revealed ill-defined lesions in left parapharyngeal, carotid space and right upper jugular region. After clinical evaluation, cardiac pacemaker was placed, but he still suffered from the syncope. Then, he received the chemotherapy with docetaxel and cisplatin. The last hypotension event occurred on day 10 of the chemotherapy. Six months after 3 cycles of chemotherapy, he remained in complete remission and resolution of syncope. We report a case in which syncope was associated with a recurrence of tonsilar cancer and successfully treated with chemotherapy.

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope

“…Syringomyelia-induced disruption of sympathetic fibers in the thoracic spinal cord is a rare mechanism of syncope. 599 Neck/vagal tumor 600,601 Recurrent syncope is an uncommon complication of neck malignancy.…”

Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit

“…There are few studies on treating HNC or TC with chemotherapy alone. [14,15] In this case, syncope frequently occurred with hypotension and bradycardia. Therefore, chemotherapy was the primary choice.…”

Recurrent Syncope in a Cancer Patient: A Case Report and Review of the Literature

“…Several case reports have been published with circumstances similar to those seen in our patient. Most recently, two groups reported resolution of syncopal episodes with tumor regression with chemotherapy [ 19 , 20 ]. In one case, the patient had a pacemaker placed but continued to faint.…”