頸動脈洞症候群による失神発作を繰り返した舌がん頸部再発の1例

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  • A case of carotid sinus syndrome with syncopal attacks associated with recurred neck metastasis from oral cancer

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Syncopal attacks associated with carotid sinus syndrome （CSS） are rare in cases of head and neck malignancy. Here, we report a case of CSS with syncopal attacks in a patient with recurrent neck metastasis from oral cancer. A 46-year-old man presented with a painful mass of the tongue. Upon clinical diagnosis of oral cancer of the tongue （T4aN2bM0）, radical neck dissection, supraomohyoid neck dissection, subtotal glossectomy, and reconstruction using free rectus abdominis myocutaneous flap were performed. Pathological findings of tissue samples from the neck dissection revealed multiple positive lymph nodes; therefore, chemoradiotherapy （CDDP, 5FU＋RTx 60Gy） was administered.<br>Three months after the chemoradiotherapy, frequent syncope attacks occurred with low blood pressure and bradycardia. Computed tomography showed a 36mm irregular mass with infiltration at the bifurcation of the carotid artery. A diagnosis of recurrent neck metastasis from oral cancer with CSS was made and weekly chemotherapy with cetuximab and paclitaxel was administered 24 times. The treatment induced a partial response and the syncopal attacks ceased. The patient was discharged from hospital and with continuous outpatient chemotherapy showed improved levels of activities of daily living. Chemotherapy for unresectable recurrent neck metastasis is suggested to be an effective treatment in cases of CSS with syncopal attacks.

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