Botulinum toxin in the treatment of post-radiosurgical neck contracture in head and neck cancer: a novel approach.

Abstract

UNLABELLED:

Neck pain affects a third of patients following head-and-neck cancer treatment, whether by radiation therapy or surgery. It is a disabling condition and the associated muscle contractures impair cervical motion. Type-A botulinum toxin is an analgesic and muscle relaxant, able to improve patients' quality of life. We here report our experience with botulinum toxin in post-radiosurgical neck contracture.

PATIENTS AND METHODS:

A single-center pilot study was run from January 2007 to July 2008, respecting the Declaration of Helsinki. All patients in complete remission from head-and-neck cancer with post-radiosurgical neck contracture impairing neck motion were included. Pain and functional impairment were assessed on a neck-function disability scale before and 1 month after botulinum toxin injection. Efficacy duration was measured. Complications at the injection site or related to drug diffusion were investigated.

RESULTS:

Nine consecutive patients (six male, three female; mean age, 61 years [range, 52-73 years]) were included. In six patients, the sternocleidomastoid muscle was injected and the muscular pedicle of a pectoralis major flap in three. Mean cervical disability score fell significantly from 33 to 23 (P=0.01). There were no complications. Efficacy was seen at a mean 6 days, and analgesia and muscle relaxation lasted for a mean 19 days.

CONCLUSION:

In post-radiosurgical neck contracture, botulinum toxin injection is a simple and easy procedure able to improve neck motion and reduce neck pain in head-and-neck cancer patients. A phase-II prospective study to determine injection sites and dosage should help bear out these preliminary findings.

• Authors: C-A Bach, I Wagner, X Lachiver, B Baujat, F Chabolle
• Journal: European annals of otorhinolaryngology, head and neck diseases (Eur Ann Otorhinolaryngol Head Neck Dis) Vol. 129 Issue 1 Pg. 6-10 (Feb 2012) ISSN: 1879-730X [Electronic] France
• PMID: 22104582 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Aged
• Botulinum Toxins, Type A (therapeutic use)
• Contracture (drug therapy, etiology)
• Female
• Head and Neck Neoplasms (radiotherapy, surgery)
• Humans
• Male
• Middle Aged
• Neuromuscular Agents (therapeutic use)
• Pilot Projects
• Postoperative Complications (drug therapy)
• Radiation Injuries (drug therapy)