Persistent hiccup after chemo-radiotherapy in nasopharyngeal cancer: an atypical side effect?

An Unusual Clinical Manifestation of Nasopharyngeal Cancer Treatment: The Curious Case of Hiccups

Nasopharyngeal carcinoma (NPC) is a rare malignancy with distinct racial and geographic distribution. Due to its proximity to critical structures, NPC presents with a diverse range of symptoms and is best treated with conformal concurrent chemoradiotherapy. We report the case of a 45-year-old male diagnosed with NPC, referred for radiation therapy after receiving three cycles of neoadjuvant chemotherapy. The patient was planned for volumetric arc radiotherapy with concurrent cisplatin, following the current standard of care. The initial phase of treatment was well tolerated; however, by the 4th week, the patient developed persistent hiccups unresponsive to conservative management. A re-evaluation of the treatment plan revealed a maximum brainstem dose of 54.32 Gy. It was hypothesized that radiation-induced edema may have stimulated the vagus nerve, leading to hiccups. The patient was treated with chlorpromazine and injectable steroids, resulting in rapid symptom resolution within 5 days.

Hiccups: An atypical side effect experienced during chemo-radiotherapy in carcinoma nasopharynx

ABSTRACT

Nasopharyngeal carcinoma is an uncommon cancer but has a distinct racial and geographic distribution. Patient presents with constellation of signs and symptoms due to its vicinity to critical structures and are best treated by conformal concurrent chemo-radiotherapy. We present a case of 45-year-old male diagnosed with carcinoma nasopharynx, referred to us for radiotherapy after three cycles of neoadjuvant chemotherapy. As per the prevailing standard of care, patient was planned for radiotherapy by volumetric arc technique with concurrent cisplatin. Initial days of treatment were uneventful. After fourth week of treatment, patient developed persistent hiccup which was not relieved on conservative medications. Plan was re-evaluated and it revealed maximum dose of 54.6 Gy to the brainstem. Radiotherapy induced edema that could have stimulated vagus nerve leading to hiccups was suspected. Patient was started on injectable steroid and chlorpromazine. There was prompt recovery from the symptom within five days of conservative treatment.

Implications of photodynamic cancer therapy: an overview of PDT mechanisms basically and practically

BACKGROUND

Tumor eradication is one of the most important challengeable categories in oncological studies. In this account, besides the molecular genetics methods including cell therapy, gene therapy, immunotherapy, and general cancer therapy procedures like surgery, radiotherapy, and chemotherapy, photodynamic adjuvant therapy is of great importance. Photodynamic therapy (PDT) as a relatively noninvasive therapeutic method utilizes the irradiation of an appropriate wavelength which is absorbed by a photosensitizing agent in the presence of oxygen. In this procedure, a series of events lead to the direct death of malignant cells such as damage to the microvasculature and also the induction of a local inflammatory function. PDT has participated with other treatment modalities especially in the early stage of malignant tumors and has resulted in decreasing morbidity besides improving survival rate and quality of life. High spatial resolution of PDT has attracted considerable attention in the field of image-guided photodynamic therapy combined with chemotherapy of multidrug resistance cancers. Although PDT outcomes vary across the different tumor types, minimal natural tissue toxicity, minor systemic effects, significant reduction in long-term disease, lack of innate or acquired resistance mechanisms, and excellent cosmetic effects, as well as limb function, make it a valuable treatment option for combination therapies.

SHORT CONCLUSION

In this review article, we tried to discuss the potential of PDT in the treatment of some dermatologic and solid tumors, particularly all its important mechanisms.

Persistent hiccup reflex activation as a complication of dental implant surgery: a case report

Persistent hiccup can conceal life-threatening clinical conditions of highly heterogeneous nature. Here, we report a case of a persistent hiccup that has been temporally associated with dental implant insertion in a patient with paroxysmal atrial fibrillation. This 67-year-old patient underwent dental implant in area 36 and the procedure was performed without acute complications. A prolonged hiccup started ~48 h after the procedure: it failed to respond to several medications and it lasted for ~18 days, after which it spontaneously disappeared. Brain imaging and neurological examination were conducted in order to rule out organic conditions, even though all the investigations resulted to be negative. We suggest that the surgical procedure might have triggered a prolonged reflex activation. Knowledge about this complication of oral surgery procedure might be useful for avoiding unnecessary hospitalization or diagnostic tests.