Dropped head syndrome suspected due to oxaliplatin used in adjuvant chemotherapy for gastric cancer: a case report.

IF 0.7 Q4 SURGERY
Yuta Marunaka, Takuma Ohashi, Takeshi Kubota, Keiji Nishibeppu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
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Abstract

Background: Dropped head syndrome (DHS) is caused by dysfunction of the cervical musculature. It is classified into two groups according to the cause: one is weakness of the neck extensors and the other is hypercontraction of the cervical flexors associated with Parkinson's disease and other disorders. Although some drugs have previously been reported as suspected causes of DHS, we are unaware of any reports in which oxaliplatin was suspected. In this report, we describe a case of DHS during adjuvant chemotherapy for gastric cancer, along with a review of the relevant literature.

Case presentation: A 72-year-old man was diagnosed with gastric cancer, cT3N0M0 cStage IIB, and underwent laparoscopic total gastrectomy with D2 lymphnode dissection and Roux-en-Y reconstruction. The operative time was 311 min, intraoperative blood loss was 40 g, and he was discharged without any post-operative complications. The histopathological diagnosis was pT4aN2M0 pStage IIIA, and S-1 + oxaliplatin (SOX) therapy was started as adjuvant chemotherapy. On the 4th course of SOX, he complained of neck heaviness and a blood test revealed that his creatine kinase (CK) level was elevated to 2464 IU/L. After consultation with an orthopedic surgeon and a neurologist, DHS due to localized cervical extensor myositis was suspected. Therefore, the 6th course of SOX was postponed, and 30 mg of oral steroids were initiated. His symptoms improved, and his CK level decreased within 2 weeks. After resuming S-1 monotherapy and tapering off oral steroids, no recurrence of symptoms has been observed.

Conclusions: We experienced one case of DHS during adjuvant chemotherapy for gastric cancer. If DHS develops after starting oxaliplatin, involvement of the drug should be suspected, and discontinuation of chemotherapy and introduction of oral steroids should be considered.

疑因奥沙利铂用于胃癌辅助化疗导致的垂头综合征:病例报告。
背景:低头综合征(DHS)是由颈部肌肉功能障碍引起的。根据病因可分为两类:一类是颈部伸肌无力,另一类是与帕金森病和其他疾病相关的颈屈肌过度收缩。尽管以前曾有报道称某些药物可能是导致 DHS 的原因,但我们尚未发现任何疑似奥沙利铂的报道。在本报告中,我们描述了一例胃癌辅助化疗期间的 DHS 病例,并回顾了相关文献:一名 72 岁的男性被诊断为胃癌(cT3N0M0 cStage IIB),并接受了腹腔镜全胃切除术、D2 淋巴结清扫术和 Roux-en-Y 重建术。手术时间为 311 分钟,术中失血 40 克,术后无任何并发症。组织病理学诊断为 pT4aN2M0 p 分期 IIIA,并开始接受 S-1 + 奥沙利铂(SOX)辅助化疗。在SOX治疗的第4个疗程,他主诉颈部沉重,血液检查显示其肌酸激酶(CK)水平升高至2464 IU/L。骨科医生和神经科医生会诊后,怀疑是局部颈伸肌炎引起的 DHS。因此,第 6 个疗程的 SOX 被推迟,并开始口服 30 毫克类固醇。两周内,他的症状有所改善,肌酸激酶水平也有所下降。在恢复 S-1 单药治疗并逐渐停用口服类固醇后,症状没有复发:我们在胃癌辅助化疗期间遇到了一例 DHS。如果在开始奥沙利铂治疗后出现 DHS,应怀疑与药物有关,并应考虑停止化疗和使用口服类固醇。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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