Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-020-05932-w HEAD AND NECK Long‑term neuromusculoskeletal side efects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy Aysegul Ucuncu Kefeli 1  · Canan Sanal‑Toprak 2  · Ruslan Asedov 3  · Zeynep Ozen 4  · Gulseren Akyuz 2  · Faysal Dane 5  · Beste M. Atasoy 6,7 Received: 22 December 2019 / Accepted: 17 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Aim In this study, we aimed to evaluate the neuromusculoskeletal late side efects and their impact on the quality of life of patients with nasopharyngeal carcinoma treated with radiochemotherapy. Patients and methods Twenty-seven patients were included. The mean follow-up was 61 months (range, 18–111 months). The median external radiotherapy dose applied to the nasopharynx and primary tumor was 70 Gy (range, 61–73 Gy). The mean dose received by the temporomandibular joint in the dose-volume histograms of these patients was 60.7 Gy. The maxi- mal doses of the muscles responsible for cervical motion in diferent ranges were greater than 60 Gy, and the mean doses were greater than 40 Gy in the muscle groups, except for the extensor muscles. Results Two patients had brachial plexus involvement, while 89% of the patients had restriction in fexion and extension movements. Of the patients, 52% had trismus. There was a signifcant correlation between extension restriction and general heath score and the physical subscale of the quality-of-life questionnaire (p = 0.01). There was also a correlation between trismus and pain killer usage (p = 0.004). Conclusion This is the frst study to analyze long-term muscle and nerve toxicity and their correlation between doses in nasopharyngeal cancer patients following radiochemotherapy. Despite the advances in radiotherapy techniques, it is neces- sary to pay attention to the doses of the nerves and muscles for late efects. Keywords Nasopharyngeal cancer · Radiotherapy · Brachial plexus · Late efects · Neuromusculoskeletal Abbreviations NPC Nasopharyngeal cancer RT Radiotherapy CT Chemotherapy RIF Radiation-induced fbrosis IMRT Intensity-modulated RT BP Brachial plexus RTOG Radiation therapy oncology group TMJ Temporomandibular joint EMG Electromyography NCSs Nerve conduction studies AANEM American Association of Neuromuscular & Electrodiagnostic Medicine EORTC European Organisation for Research and Treat- ment of Cancer CTS Carpal tunnel syndrome * Beste M. Atasoy bmatasoy@yahoo.com https://www.researchgate.net/profle/Beste_Atasoy https://www.linkedin.com/in/beste-atasoy-77197210/ 1 Faculty of Medicine, Department of Radiation Oncology, Kocaeli University, Kocaeli, Turkey 2 School of Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey 3 Marmara University Pendik Education and Research Hospital Radiology Clinic, Istanbul, Turkey 4 Acıbadem Altunizade Hospital Radiation Oncology Clinic, Istanbul, Turkey 5 School of Medicine, Department of Internal Medicine Division of Medical Oncology, Marmara University, Istanbul, Turkey 6 School of Medicine, Department of Radiation Oncology, Marmara University, Istanbul, Turkey 7 S.B.-M.Ü. Pendik Egitim ve Arastırma Hastanesi Radyasyon Onkolojisi Klinigi, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 6 Pendik 34899, Istanbul, Turkey