Vocal Cord Palsy Post Chemoradiation in Head and Neck Cancer: Challenges After Cure

Chemoradiotherapy plays an important role in treatment of head and neck cancer. Though it enables cure, it is also associated with range of side effects. Vocal cord palsy is rare, under reported, but can be life threatening. To understand how chemo radiation impacts the vocal cords is critical for effective case management and treatment planning. We conducted a comprehensive electronic search across Cochrane, EMBASE, and PubMed to identify relevant studies. A Google search was also performed using the keywords to ensure the inclusion of all articles reporting vocal cord palsy following treatment for head and neck cancer. Out of 65 articles, 24 were included for analysis to understand the pathophysiology of radiation- or chemotherapy-induced vocal cord paralysis. Additionally, eight articles that reported cases of vocal cord palsy in head and neck cancer other than nasopharyngeal and oropharyngeal were reviewed in detail case wise. The incidence of radiation-induced neuropathy ranges from 1 to 9%. The cranial nerves most commonly affected are the vagus, trigeminal, spinal accessory, oculomotor, abducens, optic, and hypoglossal nerves, with the damage being irreversible. Most cranial nerve neuropathies occur following radiation to the skull baseor neck. In head and neck cancer, nasopharyngeal cancer is most frequently associated with vocal cord palsy after radiation, typically occurring 2 to 10 years posttreatment. Bilateral involvement is more common, though in cases of unilateral involvement, the left vocal cord is more often affected. A detailed review of radiationinduced vocal cord palsy in laryngeal and hypopharyngeal cancers has been conducted. It is essential to rule out recurrence before attributing the palsy to radiation. Chemotherapy-induced vocal cord palsy, which is usually bilateral, typically occurs during chemotherapy and often reverses upon discontinuation of the causative agent. Vocal cord palsy post chemo radiation in head and neck cancer represents a journey of from cure to challenge. It may be a silent struggle for many, but can be very serious for some. Hence, it should not be ignored. Thorough documentation of vocal cord status post treatment is important in follow up for head and neck cancer. Understanding the effects of organ preservation strategies helps in making more informed decisions for patients and plan appropriately.