Idiopathic vocal cord paralysis in the radiated neck: a harbinger for malignant peripheral nerve sheath tumour.

OBJECTIVE

Patients with previous neck external beam radiotherapy (XRT) diagnosed with idiopathic vocal cord paralysis (VCP) can harbour sinister pathology. A case series of such patients found to have vagal malignant peripheral nerve sheath tumours (MPNSTs) is presented and combined with a literature review. Management and survival outcomes are analyzed.

DESIGN

Case series and systematic literature review.

SETTING

Academic tertiary care cancer centre.

METHODS

The University of Alberta's head and neck mass database was gleaned for vagal XRT-induced MPNSTs (2001-2011). Charts were reviewed for patient and tumour demographics, diagnostic methods, pathology, treatment, and survival. A systematic literature review identified similar patients.

MAIN OUTCOME MEASURES: Kaplan-Meier estimated actuarial survival rates were the primary outcome. Secondary outcomes included the mean time from XRT to presentation and to tumour recurrence as well as a summary of patient/tumour characteristics, diagnostic methods, and treatment options.

RESULTS

Two institutional and seven additional literature-wide cases were found. The median age was 34 years, the median time from XRT to MPNST was 22 years, and all patients were surgically treated. The median time from surgery to recurrence was 2.5 years. Estimated 2- and 5-year survival rates were 71% and 54%, respectively.

CONCLUSION

XRT-induced MPNST can present as idiopathic VCP two decades post-XRT. Treatment is surgical and offers acceptable survival.