February 2025 Cancer Rehabilitation Tumor Board-Session Recording

Video Transcription

Video Summary

Dr. Ekta Gupta, now Sharma, from M.D. Anderson presents a complex case of a 58-year-old male patient with a history of right tonsillar squamous cell carcinoma treated in 2012. Since 2017, he has experienced radiation-induced complications like fibrosis, dysphagia, and spasms. Botox was initially used for treatment, but spasms worsened, leading to increased dose and referrals for additional therapies. By 2022, new issues such as severe spasms and dysphagia emerged, prompting Botox adjustments and the addition of a cervical spinal cord stimulator. In Dec 2022, the stimulator improved pain by 50% but didn’t change spasms significantly. The patient continued experiencing progression in symptoms, including esophageal spasms and jaw trismus. At the end of 2024, a Prialt pump was attempted, later switched to Baclofen with marked improvement. Still, concerns remain over airway compromise. Discussions suggest exploring Dysport as an alternative to Botox, considering muscle and injection adjustments, and evaluating for potential concurrent neuromuscular conditions. This ongoing case highlights the progressive nature of radiation fibrosis and the challenges in managing complex post-treatment complications.

Keywords

radiation fibrosis

squamous cell carcinoma

dysphagia

spasms

Botox

cervical spinal cord stimulator

Prialt pump

Baclofen

Dysport