A Case of Unilateral Recurrent Nerve Palsy Improved by Chemotherapy for Esophageal Cancer

Abstract

There are three causes of unilateral recurrent nerve palsy:postoperative, idiopathic, and tumor disease. When tumor invasion of the recurrent nerve is observed, nerve palsy is difficult to improve. In the present case, we experienced a case in which recurrent nerve palsy improved after chemotherapy for esophageal cancer. The patient was a 65-year-old man with advanced esophageal cancer (cT4bN2M1, cStage IVb) who was treated with CDDP+5-FU at the Department of Clinical Oncology of our hospital. He was referred to our department for close examination of his hoarseness, which had worsened since the start of treatment. Laryngoscopy revealed left vocal cord paralysis with arcuate changes, and CT scan revealed a primary tumor in the upper esophagus, multiple lymph node metastases, and lung metastases. The regimen was changed to nivolumab due to tumor progression. Laryngoscopy performed 205 days after the start of treatment showed improvement of left vocal cord paralysis. In general, nerve preservation is difficult in patients with malignant tumors due to direct nerve invasion or concurrent resection at surgery, and improvement of recurrent nerve palsy is not expected. Among peripheral neuropathies, however, in the case of neurapraxia, complete recovery of neuropathy is possible. In the present case, nerve compression by the cancer caused neurapraxia, and shrinkage of the cancer by chemotherapy was considered to have improved the recurrent nerve palsy.