Multiple Cranial Nerve Palsies After Reirradiation With Proton Therapy in Nasopharyngeal Carcinoma: A Case Report

Abstract Nasopharyngeal carcinoma (NPC) is a rare form of cancer that has a strong association with the Epstein-Barr virus. There is little consensus on treatment for recurrent NPC, and depending on the extent of the disease, options include surgery, reirradiation, or enrollment in a clinical trial. Reirradiation, although a common and accepted treatment for recurrent NPC, carries a risk of significant late toxicity. Here, we describe the case of a young patient who experienced multiple cranial neuropathies after reirradiation for NPC recurrent to an intraparotid lymph node. The patient, while disease-free, continues to have symptoms related to these neuropathies, with significant atrophy of the left side of the tongue, dysphonia, and a winged scapula, and the focus of care is now on improving his overall quality of life. Further research is needed to explore the effects of systemic therapies on cranial nerves, as well as strategies to reduce the risk of damage to these structures.