An Unusual Clinical Manifestation of Nasopharyngeal Cancer Treatment: The Curious Case of Hiccups.

Abstract

Nasopharyngeal carcinoma (NPC) is a rare malignancy with distinct racial and geographic distribution. Due to its proximity to critical structures, NPC presents with a diverse range of symptoms and is best treated with conformal concurrent chemoradiotherapy. We report the case of a 45-year-old male diagnosed with NPC, referred for radiation therapy after receiving three cycles of neoadjuvant chemotherapy. The patient was planned for volumetric arc radiotherapy with concurrent cisplatin, following the current standard of care. The initial phase of treatment was well tolerated; however, by the 4^th week, the patient developed persistent hiccups unresponsive to conservative management. A re-evaluation of the treatment plan revealed a maximum brainstem dose of 54.32 Gy. It was hypothesized that radiation-induced edema may have stimulated the vagus nerve, leading to hiccups. The patient was treated with chlorpromazine and injectable steroids, resulting in rapid symptom resolution within 5 days.