Managing Late Effects of Nasopharyngeal Cancer Radiation Therapy

Late effects of radiotherapy for nasopharyngeal carcinoma?

Hello Dr.
Zheng, my father is 64 years old and was diagnosed with nasopharyngeal carcinoma 29 years ago.
He underwent radiation therapy at that time, which resulted in hearing loss in his right ear.
However, starting in May of this year, he began experiencing pain, purulent discharge, and a foul odor from his right ear, which severely affected his nasal congestion and led to excessive mucus production, making it difficult for him to sleep.
He also developed a hoarse throat and had difficulty opening his mouth to eat, being limited to soft foods like porridge and noodles, resulting in malnutrition; he is 160 cm tall and weighs only 38.4 kg.
He returned to the original hospital (Hospital A) where he was treated 29 years ago for an examination.
The doctor reviewed the reports and stated that due to my father's poor health, surgery could not be performed, and he needed to receive iron supplements before any decisions could be made.
After the iron treatment, my father felt unwell in early August and went to another hospital (Hospital B) for examination, where he was admitted that same night for a series of CT scans and MRIs.
During his stay, the antibiotics administered by Hospital B alleviated his ear pain, but he continued to have issues with eating and sleeping.
The examination results indicated that the radiation therapy from 29 years ago had caused necrosis of the temporal bone, leading to these complications.
Initially, Hospital B expressed willingness to perform surgery, but warned of potential facial deformities and significant risks.
After considering this, my father opted not to have surgery.
Hospital B, believing that he would not proceed with surgery, completed their treatment and discharged him.
However, as my father's condition worsened, he decided to pursue surgery and returned to Hospital A to arrange for it.
The doctor at Hospital A stated that this was not his specialty and referred him to another physician, which left us quite astonished.
This new doctor arranged for a CT scan and indicated that they would review the results with an oncologist afterward.
Since the examinations had already been conducted at Hospital B, we returned to see the physician there, who stated that my father's condition "cannot be operated on." They explained that this was a complication from the radiation therapy 29 years ago that must be faced, and superficial reports did not indicate cancer.
If further examinations were to be conducted, it would require extensive surgery to remove the bone behind the right ear, which seemed unfeasible.
The doctor stated that any further radiation therapy, chemotherapy, or hyperbaric oxygen treatment would be ineffective, and all symptoms would continue to worsen, potentially leading to severe complications such as brain hemorrhage or stroke.
We feel completely helpless! Is there truly no treatment option available to improve my father's condition?

Nìmíng, 30~39 year old female. Ask Date: 2018/09/13

Dr. Zheng Jueyi reply Otolaryngology

Hello, if the symptoms persist without improvement, it is recommended to visit an otolaryngologist for an examination of the oropharynx, and to arrange for an upper gastrointestinal endoscopy with a gastroenterologist to check for any related issues.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/09/13

More Info

Managing the late effects of radiation therapy for nasopharyngeal cancer can be a complex and challenging process, especially when the patient has experienced significant complications over the years. Your father's situation, having undergone radiation therapy nearly three decades ago, has led to severe complications, including hearing loss, ear pain, nasal obstruction, and nutritional deficiencies. These late effects are not uncommon in patients who have received radiation therapy, particularly in sensitive areas such as the head and neck.

Radiation therapy can cause a variety of late effects due to the damage it inflicts on surrounding healthy tissues. In your father's case, the necrosis of the temporal bone, as indicated by the diagnosis from the second hospital, is a serious condition that can arise from radiation-induced damage. This condition can lead to chronic pain, infection, and functional impairments, such as difficulty swallowing and sleeping, as you have described.

The management of such late effects often requires a multidisciplinary approach. Here are some potential avenues for addressing your father's symptoms and improving his quality of life:
1. Pain Management: Given your father's ongoing pain, it is crucial to manage this effectively. This may involve medications such as analgesics, anti-inflammatory drugs, or even opioids if the pain is severe. Palliative care specialists can provide additional support in managing pain and improving comfort.

2. Nutritional Support: Since your father is struggling with nutrition due to his inability to eat solid foods, consulting with a nutritionist or dietitian is essential. They can recommend high-calorie, nutrient-dense liquid supplements that can help maintain his weight and nutritional status. In some cases, enteral feeding (via a feeding tube) may be considered if oral intake remains inadequate.

3. Speech and Swallowing Therapy: A speech-language pathologist can work with your father to improve his swallowing function and help him manage any difficulties with speech. They can provide exercises and strategies to enhance his ability to eat and communicate.

4. Infection Management: The presence of infection in the ear and nasal passages needs to be addressed promptly. If antibiotics have been effective in alleviating ear pain, it may be necessary to continue monitoring for signs of infection and to manage any ongoing issues with nasal drainage.

5. Surgical Consultation: While the initial assessments indicated that surgery might not be an option, it may be worthwhile to seek a second opinion from an otolaryngologist (ENT specialist) who has experience with post-radiation complications. They may have alternative surgical approaches or interventions that could alleviate some of the symptoms.

6. Psychosocial Support: The emotional and psychological toll of dealing with chronic health issues can be significant. Engaging with mental health professionals or support groups can provide your father and your family with the emotional support needed during this challenging time.

7. Regular Monitoring: Continuous follow-up with healthcare providers is essential to monitor your father's condition and adjust treatment plans as necessary. This includes regular imaging studies and assessments to ensure that any new developments are addressed promptly.

It is understandable to feel overwhelmed by the complexity of your father's condition and the limitations of current medical interventions. However, it is important to remain proactive in seeking out supportive care options and advocating for your father's needs. While some late effects of radiation therapy may not be reversible, there are often ways to manage symptoms and improve quality of life. Engaging a team of healthcare professionals who specialize in late effects of cancer treatment can provide valuable insights and support.

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