Cranial neuropathy following curative chemotherapy and radiotherapy for carcinoma of the nasopharynx

Cranial nerve damage following head and neck radiotherapy is an unusual eve nt. Cranial neuropathy following concurrent chemotherapy and radiotherapy i s unreported. The authors report a case of a 54-year-old man treated with c urative chemotherapy and radiotherapy for a stage III nasopharyngeal carcin oma who developed an unilateral hypoglossal nerve palsy five years after th erapy. Follow-up examination and magnetic resonance imaging (MRI) show no e vidence of recurrent disease. Hypoglossal nerve injury occurring after head anti neck radiotherapy is an indirect effect due to progressive soft tissu e fibrosis and loss of vascularity. This process develops over years leadin g to nerve entrapment and permanent damage. Cranial nerve palsies, includin g damage to the hypoglossal nerve, can develop years after therapy with no evidence of tumour recurrence. Chemotherapy and radiotherapy have improved progression-free and overall survival in advanced nasopharyngeal cancer. As more patients achieve long-term tumour control following chemotherapy and radiotherapy, we must be cognizant of potential late injury to cranial nerv es.