Life threatening laryngeal toxicity following treatment with combined chemoradiotherapy for nasopharyngeal cancer: A case report with review of the literature

Nasopharyngeal carcinoma is a rare cancer in Western society, however there is a higher incidence in Asian, Chinese and African populations. A signifi cant number of Asians reside in Australia, and consequently patients with n asopharyngeal carcinoma are an increasing clinical problem. Radiotherapy ha s been the predominant treatment in the past, but more recently multi-modal ity treatments have been utilised. The results of an Intergroup trial, coor dinated by the Southwest Oncology Group (SWOG) demonstrated markedly superi or progression free and overall survival for combined chemoradiotherapy com pared to radiotherapy alone. At three years progression free survival was 2 4% for the radiotherapy arm and 69% for the chemoradiotherapy group (P < 0. 001), and three-year survival was 47% for the radiotherapy arm compared wit h 78% for the combined arm (P = 0.005). There was minimum toxicity reported for either of the arms and no treatment related deaths. Based on these sur vival data the administration of concomitant cisplatin and radiotherapy has become standard of care for nasopharyngeal carcinoma in the USA. Our insti tution has also adopted a similar combined therapy protocol for patients wi th stage III and IV nasopharyngeal cancer and good performance status. The patients treated at our institution have experienced significant side effec ts. We describe the case of a woman so treated with this protocol who subse quently developed severe life threatening laryngeal necrosis.