The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis

Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.

Osteoradionecrosis of the occipitocervical junction: A rare case of C1 anterior arch disruption

We report the case of a 57-year-old man who developed osteoradionecrosis (ORN) at the occipitocervical (OC) junction after radiation therapy for nasopharyngeal carcinoma. During soft-tissue debridement using a nasopharyngeal endoscope, the anterior arch of the atlas (AAA) was spontaneously disrupted, which was later spat out. Radiographic examination revealed complete disruption of the AAA that caused OC instability. We performed posterior OC fixation. The patient experienced successful postoperative pain relief. AAA disruption secondary to ORN at OC junction can cause severe instability. Posterior OC fixation alone may be an effective procedure if the necrotic pharyngeal region is mild and endoscopically controllable.

Pyogenic spondylitis caused by Streptococcus dysgalactiae subspecies equisimilis in a patient with nasopharyngeal cancer

In the treatment of head and neck cancer, radiation therapy is an effective modality and is often used in routine clinical practice. Although rare, pyogenic spondylitis has been reported as a complication of radiation therapy. Here, we report a case of nasopharyngeal carcinoma resulting in pyogenic spondylitis from a catheter-related bloodstream infection after chemoradiotherapy. The initial symptoms were fever and posterior cervical pain. Streptococcus dysgalactiae subspecies equisimilis was detected in blood cultures. Magnetic resonance imaging showed abnormal enhancement of the C6 and C7 vertebrae and an anterior epidural abscess. The infection was successfully treated with antibacterial therapy.

Differentiation of Cervical Spine Osteoradionecrosis and Bone Metastasis After Radiotherapy Detected by Bone Scan in Patients With Nasopharyngeal Carcinoma: Role of Magnetic Resonance Imaging

Background: Osteoradionecrosis (ORN) of the cervical spine is a serious complication after radiotherapy (RT), which may show increased radiotracer uptake on a bone scan (BS) and be mistaken as metastasis. We aimed to assess the value of magnetic resonance imaging (MRI) in the differentiation of cervical spine ORN from bone metastasis after RT detected by BS in nasopharyngeal carcinoma (NPC).

Methods: In this retrospective study, 35 NPC patients who had undergone RT were enrolled, of whom 21 patients showed cervical spine ORN and 14 showed bone metastasis. New areas of increased radiotracer uptake in the cervical spine on a BS were noted in all patients, following which the patients underwent neck MRI for further assessment. Two radiologists independently reviewed two sets of images including a BS set and an MRI set (MRI with BS) and reached a consensus. The diagnostic sensitivity, specificity, and accuracy for ORN detection were calculated, and interobserver agreement was evaluated using the kappa test.

Results: A total of 75 cervical spine lesions were identified (44, ORN; 31 metastases). The BS set analysis showed that the diagnostic sensitivity, specificity, and accuracy were only 38.6, 48.3, and 42.7%, respectively, for differentiation of cervical spine ORN from bone metastasis. On the other hand, the MRI set analysis showed that the diagnostic sensitivity, specificity, and accuracy increased to 86.4, 90.3, and 88.0%, respectively. The interobserver agreement for the MRI set was determined to be very good (κ = 0.92).

Conclusion: MRI is a reliable technique for the further discrimination of emerging cervical spine lesions after RT detected by BS. Furthermore, it could be a better differential diagnosis technique for distinguishing ORN from metastasis and may help avoid a wrong assignment of the patient to a metastatic stage with indication for treatment with supplemental toxicity and a subsequent palliative strategy.