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Rieken S, Kronziel LL, Langer T, Rades D, Boppel T, Trillenberg P, Gebauer J. Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature. J Cancer Res Clin Oncol 2023; 149:17865-17879. [PMID: 37947868 PMCID: PMC10725355 DOI: 10.1007/s00432-023-05480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS. METHODS A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy. RESULTS Two hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain. CONCLUSIONS A relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk. IMPLICATIONS FOR CANCER SURVIVORS Integration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.
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Affiliation(s)
- Sarah Rieken
- Department of Oncology and Hematology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Lea Louisa Kronziel
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - Thorsten Langer
- Department of Pediatric Oncology and Hematology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Judith Gebauer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Inoue R, Sawamura M, Yoshimura M, Takahashi R. Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles. BMJ Case Rep 2022; 15:e252446. [PMID: 36368727 PMCID: PMC9660595 DOI: 10.1136/bcr-2022-252446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryoichi Inoue
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Sawamura
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Molecular and Biologic Targets for Radiation Fibrosis: Implications for Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brodell JD, Sulovari A, Bernstein DN, Mongiovi PC, Ciafaloni E, Rubery PT, Mesfin A. Dropped Head Syndrome: An Update on Etiology and Surgical Management. JBJS Rev 2021; 8:e0068. [PMID: 32105239 DOI: 10.2106/jbjs.rvw.19.00068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
» Dropped head syndrome is a group of disorders with diverse etiologies involving different anatomical components of the neck, ultimately resulting in a debilitating, flexible, anterior curvature of the cervical spine.
» Causes of dropped head syndrome include myasthenia gravis, amyotrophic lateral sclerosis, Parkinson disease, radiation therapy, and cumulative age-related changes. Idiopathic cases have also been reported.
» Nonoperative treatment of dropped head syndrome includes orthotic bracing and physical therapy.
» Surgical treatment of dropped head syndrome consists of cervical spine fusion to correct the deformity.
» The limited data available examining the clinical and radiographic outcomes of surgical intervention indicate a higher rate of complications with the majority having favorable outcomes in the long term.
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Affiliation(s)
- James D Brodell
- Departments of Orthopaedics and Rehabilitation (J.D.B., A.S., D.N.B., P.T.R., and A.M.) and Neurology (P.C.M. and E.C.), University of Rochester, Rochester, New York
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Knowlton SE, Zheng M, Diamond Y, Yakaboski M, Ruppert LM. Bracing to treat dropped head syndrome in cancer patients: A retrospective review. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2021; 33:20-25. [PMID: 36186001 PMCID: PMC9524241 DOI: 10.1097/jpo.0000000000000285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Sasha E. Knowlton
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mimi Zheng
- Department of Rehabilitation Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
- Department of Rehabilitation Medicine, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY
| | - Yoni Diamond
- Hanger Clinic, Prosthetics and Orthotics, New York, NY
| | | | - Lisa M. Ruppert
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Rehabilitation Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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Di Stefano V, Attanasi C, Ferrante C, Di Muzio A. Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma. BMJ Case Rep 2018; 11:11/1/e226822. [PMID: 30567263 DOI: 10.1136/bcr-2018-226822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dropped head syndrome (DHS) is a rare condition, characterised by weakness of the cervical paraspinal muscles with sagging of the head. It is usually seen in association with neurological disorders and rarely can follow radiotherapy. We report a case of a 54-year-old man survivor of Hodgkin lymphoma (HL), who developed DHS 28 years after radiotherapy. He was referred to our department due to progressive weakness and atrophy of cervical paraspinal and shoulder girdle musculature. Physical and neurophysiological examination, electromyography and MRI confirmed the diagnosis of DHS. In the following years, there was no progression of symptoms.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical sciences, "G. d' Annunzio" University, Chieti, Italy
| | - Carmine Attanasi
- Centro regionale Sant'Alessio - "Margherita di Savoia per i ciechi", Roma, Italy
| | - Camilla Ferrante
- Department of Neuroscience, Imaging and Clinical sciences, "G. d' Annunzio" University, Chieti, Italy
| | - Antonio Di Muzio
- Department of Neurology, "SS Annunziata" hospital, Chieti, Italy
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Myofascial Release and Muscle Retraining for Dropped Head Syndrome Attributed to Radiation Fibrosis in Hodgkin Lymphoma: A Case Series. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seidel C, Kuhnt T, Kortmann RD, Hering K. Radiation-induced camptocormia and dropped head syndrome: Review and case report of radiation-induced movement disorders. Strahlenther Onkol 2015; 191:765-70. [PMID: 26072168 DOI: 10.1007/s00066-015-0857-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND In recent years, camptocormia and dropped head syndrome (DHS) have gained attention as particular forms of movement disorders. Camptocormia presents with involuntary forward flexion of the thoracolumbar spine that typically increases during walking or standing and may severely impede walking ability. DHS is characterized by weakness of the neck extensors and a consecutive inability to extend the neck; in severe cases the head is fixed in a "chin to chest position." Many diseases may underlie these conditions, and there have been some reports about radiation-induced camptocormia and DHS. METHODS A PubMed search with the keywords "camptocormia," "dropped head syndrome," "radiation-induced myopathy," "radiation-induced neuropathy," and "radiation-induced movement disorder" was carried out to better characterize radiation-induced movement disorders and the radiation techniques involved. In addition, the case of a patient developing camptocormia 23 years after radiation therapy of a non-Hodgkin's lymphoma of the abdomen is described. RESULTS In total, nine case series of radiation-induced DHS (n = 45 patients) and-including our case-three case reports (n = 3 patients) about radiogenic camptocormia were retrieved. Most cases (40/45 patients) occurred less than 15 years after radiotherapy involving extended fields for Hodgkin's disease. CONCLUSION The use of wide radiation fields including many spinal segments with paraspinal muscles may lead to radiation-induced movement disorders. If paraspinal muscles and the thoracolumbar spine are involved, the clinical presentation can be that of camptocormia. DHS may result if there is involvement of the cervical spine. To prevent these disorders, sparing of the spine and paraspinal muscles is desirable.
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Affiliation(s)
- Clemens Seidel
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany.
| | - Thomas Kuhnt
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Rolf-Dieter Kortmann
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Kathrin Hering
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
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Ghosh PS, Milone M. Clinical and laboratory findings of 21 patients with radiation-induced myopathy. J Neurol Neurosurg Psychiatry 2015; 86:152-8. [PMID: 24838910 DOI: 10.1136/jnnp-2013-307447] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Limited data are available on radiation-induced myopathy (RIM) in adult cancer survivors. METHODS We retrospectively reviewed the clinical, electrophysiological, serological, radiological and pathological findings of patients with RIM seen in the neurology clinic over a 11-year period (2002-2013). RESULTS Out of 251 patients with radiotherapy-induced neuromuscular complications, 21 had RIM (11 men and 10 women). Cancers included: Hodgkin's lymphoma (13), non-Hodgkin's lymphoma (one), pinealoblastoma (one), tongue (two), nasopharyngeal (one), thyroid (one) and testicular cancer (two). Various radiotherapy protocols were used but all patients received neck and upper torso radiation. The mean latency between radiation exposure and onset of RIM was 15 years (range 2-45 years). The most common presentation was head drop (43%) followed by neck pain (38%). Axial (86%) and periscapular (81%) muscle weakness and atrophy were frequent findings. Two patients died in follow-up from hypercapnic respiratory failure secondary to neuromuscular weakness. Serum creatine kinase values were usually normal or slightly elevated. EMG revealed predominantly myopathic changes in the axial and periscapular muscles. Half of the muscle biopsies (6/12) showed myopathic changes; increased connective tissue elements were observed in seven of eight muscle biopsies performed in the irradiated field; and mitochondrial dysfunction in two. CONCLUSIONS RIM is a potential long-term neuromuscular adverse effect of radiation exposure in Hodgkin's disease and other types of cancer manifesting predominantly as head drop and can be fatal due to neuromuscular respiratory failure. Improved radiotherapy protocols might reduce the risk of RIM and other radiation-induced neuromuscular complications.
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Affiliation(s)
- Partha S Ghosh
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23 Suppl 6:634-43. [PMID: 25217239 DOI: 10.1007/s00586-014-3544-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Chin-on-chest deformity is a rare and severe condition mostly related with ankylosing spondylitis, traumas and/or cervical spine surgery. We present a case of 69 years old woman with a rare form of chin-on-chest secondary to dropped head syndrome (DHS), developed after radiotherapy for Hodgkin disease. In addition, we reviewed the few publications about this specific condition; management and surgical treatment of DHS are discussed. METHODS We performed a pedicle subtraction osteotomy (PSO) and stabilization through a posterior approach. Intraoperative monitoring using motor and somatosensory evoked potentials and wake-up test were carried out. RESULTS At 19th month follow-up, the patient reported a significant improvement of cervical pain, dysphagia and respiratory difficulty and a complete restoration of the neurological impairment. The achieved correction was successful and the patient was very satisfied by the restoration of forward gaze. CONCLUSIONS DHS is a very rare post-radiotherapy complication; there is lack of evidences in literature about its management. The only definitive treatment seems to be surgical intervention. PSO is a valid therapeutic option when fixed chin-on-chest deformity occurs; although it is a demanding technique and it presents high rate of complications, the actual neurological monitoring methods provide more intraoperative safety.
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