Schlienger M, Ferroir J-P, Huguet F, Deluen F, Pène F, Marseguerra R, Touboul E
Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
Cancer Radiother. 2013 Feb;17(1):44-9. doi: 10.1016/j.canrad.2012.10.010. Epub 2012 Dec 4.
The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.
作者报告了一例在有霍奇金淋巴瘤病史且已通过化疗和斗篷野放疗治愈的患者发生事故后出现异常快速起病的垂头综合征病例，并将此病例与这种治疗后发生的罕见慢性垂头综合征的已发表病例进行比较。一名56岁男性在36岁时根据标准技术和标准剂量（40Gy，20次分割，27天）接受了膈上型霍奇金淋巴瘤的化疗和斗篷野放疗。治疗结束17年后，他遭受了严重的挥鞭样损伤，随后迅速出现垂头综合征，类似于在霍奇金淋巴瘤背景下已描述的慢性垂头综合征病例（头部永久性屈曲，仅在仰卧位时有所减轻）。体格检查、神经生理学检查、肌电图和磁共振成像确诊为垂头综合征。对于与垂头综合征相关的严重残疾，可用的治疗选择非常少。这种亚急性起病的垂头综合征此前尚未有过描述。化疗后放疗的良好效果使得受累区域的剂量可降至30Gy。这与治疗计划方面的最新进展一起，应能消除这些并发症。
