Adverse reactions after radiotherapy for nasopharyngeal carcinoma

Ms. Wu, 48 years old, was admitted to the hospital due to "pain in the right temporal area of ​​the head and right neck and back for 8 years, which worsened for 3 months."

Medical history

The patient received radiotherapy for nasopharyngeal carcinoma 8 years ago, which led to pain in the right side of the head, neck, and back, which was chronic and progressive. Accompanied by fatigue, nasal congestion, dry mouth, sore throat, aphonia, restless sleep, and dry stool. The pain was persistent, including numbness, tingling, and stiffness in the right neck, and stiffness in the right back. He liked to press and warmth, and the pain increased when it was rainy and cold. The pain affected his sleep, and it took 2 hours to fall asleep after taking oral sleeping pills. He woke up once in less than 2 hours of sleep due to pain, dry mouth, and nasal congestion. The oncology department had changed the analgesics many times, but he was drowsy even when taking the lowest effective dose. In May 2004, he was diagnosed with clinical stage 3 nasopharyngeal carcinoma, and then he underwent radiotherapy and chemotherapy simultaneously, with radiotherapy and chemotherapy every Monday and radiotherapy from Tuesday to Friday. At the fifth week of treatment, the patient's weight had dropped from 56.2kg to 35.4kg. He eventually terminated the chemotherapy plan due to physical exhaustion and leukopenia, and increased the radiation dose to make up for the inadequacy of chemotherapy. A total of 5 chemotherapy sessions and 45 radiotherapy sessions were performed, which lasted for 9 weeks. During the radiotherapy, he developed ulcers in the right neck, and his throat, nasal mucosa, and salivary glands were damaged. He lost his voice in 2007. The symptoms of pain in the right temporal region of the head, right neck, and back gradually worsened.

Physical examination

The patient has a painful expression, is thin, and has a dull complexion. When seeing a doctor, he needs to write down his condition on paper. His jaws cannot open or close properly, and his tongue is difficult to stick out of his mouth. His tongue is red and has little coating and little fluid. His pulse is thin and soft. His neck is stiff, and his head is in a forced position with the head tilted to the right by about 5 degrees. The skin on the right neck is dark purple, the skin is tight, and the area is stiff and inelastic. There is extensive tenderness in the soft tissues of the neck, and the neck movement is limited. The percussion test and brachial plexus traction test are negative.

Diagnosis and treatment

The patient was diagnosed with nasopharyngeal carcinoma. Chinese medicine believes that nasopharyngeal carcinoma will cause loss of qi and yin and loss of vitality after radiotherapy and chemotherapy. The treatment is to replenish qi and yin, and to nourish the vitality. Seven doses of ginseng, ophiopogon japonicus, raw earth, dendrobium, ophiopogon japonicus, and poria were prescribed. After four follow-up visits, the main method was to replenish qi and yin, and the previous prescription was added or subtracted. After 40 days, the symptoms were significantly relieved and Qiuli paste was used for follow-up.