Survivors of oropharyngeal cancer (OPC) with late lower cranial neuropathies (LCNP) may have worsened treatment-related symptoms compared with patients without LCNP, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.

LCNP is a rare but major consequence of radiotherapy and other cancer treatments, leading to impairments in functions such as swallowing, shoulder movement, and speech. Previous reports suggest that patients who develop LCNP often have worse symptom scores and general functional impairment, but quantitative evaluations have not been performed.

For this cross-sectional survey study, researchers evaluated the outcomes of 889 survivors of OPC who underwent radiotherapy or chemoradiotherapy. Eligible patients completed OPC treatment at least 1 year prior to completing the survey, and did not have any LNCP at cancer diagnosis or before starting treatment. The MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN) was used to assess symptom severity and interference.

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Of the 889 study participants, 36 (4.0%) developed late LCNP, and the median time to onset was 5.25 years. This group was significantly associated with worse mean top 5 most severe MDASI-HN symptom scores after adjustment, including dry mouth, swallowing and chewing, mucus, fatigue, and choking, compared with patients without LCNP. Overall treatment-related symptom burden was low among all survivors.

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Multivariable analyses showed that LCNP was also significantly associated with worse individual symptoms, particularly difficulty swallowing or chewing, mucus, fatigue, choking, and voice or speech symptoms.

Late LCNP was not associated with worse activity- or psychosocial-interference scores.

The authors concluded that “the study findings suggest the need for long-term surveillance of late LCNP among patients with HNC and OPC, particularly in light of epidemiologic trends that suggest increasing numbers of OPC survivors at risk of late symptoms in the immediate years ahead. Furthermore, efforts may be necessary to lessen symptom burden associated with this disabling late burden among OPC survivors.”


Aggarwal P, Zaveri JS, Goepfert RP, et al. Symptom burden associated with late lower cranial neuropathy in long-term oropharyngeal cancer survivors [published online September 6, 2018]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2015.0540