Otolaryngology: Open Access
Open Access

Head and neck cancer, Radiation therapy, Baroreflex dysfunction, Autonomic dysfunction, Case study

Introduction

Head and neck cancer (HNC) encompasses a diverse group of malignancies arising from the oral cavity, pharynx, larynx, and other related structures. It is a significant global health concern, with over 800,000 new cases diagnosed annually worldwide (Ferlay et al., 2019). Treatment modalities for HNC often include surgery, radiation therapy, chemotherapy, or a combination thereof, depending on the stage and location of the tumor. Radiation therapy, either alone or in combination with surgery and/or chemotherapy, is a cornerstone of curative treatment for many patients with HNC. Despite its efficacy, radiation therapy can lead to various acute and late adverse effects due to the incidental irradiation of nearby normal tissues. These adverse effects may include mucositis, dysphagia, xerostomia, fibrosis, and radiation-induced neuropathy. While these complications are well-documented and managed in clinical practice, rare complications such as baroreflex dysfunction have also been reported following radiation therapy for HNC. Baroreflex dysfunction refers to impaired autonomic regulation of blood pressure, resulting in orthostatic hypotension, dizziness, syncope, and other related symptoms. Although the exact pathophysiology of baroreflex dysfunction following radiation therapy is not fully understood, it is hypothesized to involve damage to autonomic nervous system structures within the irradiated field. Here, we present a case study of a patient who developed baroreflex dysfunction following radiation treatment for HNC, highlighting the clinical presentation, diagnostic evaluation, and management strategies employed [1-5].

Case presentation

A 58-year-old male with a history of squamous cell carcinoma of the left tonsil presented to the oncology clinic with complaints of dizziness, lightheadedness, and episodes of syncope. The patient had completed definitive chemoradiation therapy for his HNC six months prior to the onset of these symptoms. Physical examination revealed orthostatic hypotension, with a drop in blood pressure of >20 mmHg upon standing, accompanied by a heart rate increase of <10 beats per minute [6].

Further evaluation, including 24-hour ambulatory blood pressure monitoring and autonomic function testing, confirmed the diagnosis of baroreflex dysfunction. Imaging studies, including magnetic resonance imaging (MRI) of the brain and cervical spine, did not reveal any evidence of structural abnormalities or metastatic disease. The patient's symptoms were deemed consistent with autonomic neuropathy secondary to radiation therapy [7].

Management

The management of baroreflex dysfunction in this patient focused on symptomatic relief and mitigating orthostatic hypotension to improve quality of life. Non-pharmacological measures included lifestyle modifications such as avoiding sudden changes in posture, increasing salt and fluid intake, and wearing compression stockings. Pharmacotherapy with fludrocortisone, midodrine, or pyridostigmine was considered for patients with refractory symptoms.

Regular follow-up visits were scheduled to monitor the patient's blood pressure, symptoms, and response to treatment. Close collaboration between oncologists, neurologists, and cardiologists was essential in managing this complex condition.

Discussion

Baroreflex dysfunction is a rare but potentially debilitating complication of radiation therapy for HNC. The precise incidence of this complication is unknown, likely due to underrecognition and underreporting in clinical practice. The pathophysiology of baroreflex dysfunction following radiation therapy remains incompletely understood but is thought to involve damage to autonomic nervous system structures within the irradiated field.

Early recognition and prompt management of bar reflex dysfunction are crucial to prevent complications such as falls, syncope, and injury. Treatment strategies may include lifestyle modifications, pharmacotherapy, and, in severe cases, the use of pacemakers or other implantable devices to modulate autonomic function [8-10].

Conclusion

Bar reflex dysfunction is a rare but potentially serious complication of radiation therapy for HNC. Clinicians should be aware of this potential complication and promptly evaluate patients presenting with symptoms suggestive of autonomic dysfunction following radiation treatment. Multidisciplinary collaboration and individualized treatment approaches are essential in managing these patients effectively and improving their quality of life.

Acknowledgement

None

Conflict of Interest

None

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