Table 4 Comparative analysis of nerve damage in the HNC treatments
From: Cancer neuroscience in head and neck: interactions, modulation, and therapeutic strategies
Treatment method | Neurological damage characteristics | Injury mechanism | Assessment method | Clinical manifestations | Incidence rate | Limitations of treatment | Current intervention measures | ||
Main damage type | Temporal feature | Reversibility | |||||||
Surgery | Mechanical injury | Acute | Partially or completely reversible | ①Neurapraxia ②Axonotmesis ③Neurotmesis | ①Preoperative imaging evaluation ②Intraoperative nerve monitoring ③Postoperative symptom assessment | Mainly related to the affected nerve, with symptoms such as hoarseness, facial palsy, pain, etc. | Cervical lymph node dissection: ①Spinal accessory nerve: 27.9–94.8% ②Facial nerve: 12.7–13.1% TC surgery (recurrent laryngeal nerve): ①Transient: 5–8% ②Permanent: 0.3-3% | ①Existing tumor nerve invasion ②Intraoperative unavoidable maneuvers | ②Neurorrhaphy or nerve grafting ②Neurotrophic drugs ③Neurorehabilitation training ④Perioperative nerve monitoring |
Individual cases are irreversible | |||||||||
Radiotherapy | Radiation injury | Acute | Partially reversible | ①DNA damage in neural cells ②Axonal damage ③Demyelination ④Neurovascular edema ⑤Chronic neuroinflammation ⑥Neurofibrosis or perineural fibrosis | ①Clinical symptoms and signs ②Imaging evaluation ③Neuroelectrophysiological examination ④Neurobiomarker detection | PNS: pain, numbness, visual impairment, olfactory dysfunction, dysphagia, dysarthria, xerostomia, etc. CNS: epilepsy, memory deficit, cognitive impairment, depression, endocrine dysfunction, etc. | ①Radiation-associated neurological injury: 2–14% ②Radiation-induced cranial neuropathy 2–9% ③NPC radiotherapy causing high-frequency hearing loss: 42.2% ④Children’s radiation-induced endocrine dysfunction: 56.9% | ①Damage to normal tissues ②Limitation of radiation dose ③Variability in tumor type response ④Cancer cell radioresistance ⑤Long-term treatment risks ⑥Patient’s physical condition requirements | ①Improving radiation delivery techniques ②Analgesics and corticosteroids ③Nerve decompression surgery ④Hyperbaric oxygen therapy ⑤Repetitive transcranial magnetic stimulation ⑥CBPT |
Delayed | Essentially irreversib | ||||||||
Chemotherapy | Toxic damage | Acute | Partially reversible | ①DNA damage in neural cells ②Ferritinophagy-induced cell death ③SC dysfunction ④Demyelination ⑤Microglial cell dysregulation | ①Chemotherapy-related neurotoxicity assessment scales ②Medical history and clinical manifestations ③Imaging evaluation ④Neuroelectrophysiological examination ⑤Neurobiomarker detection | PNS: pain, numbness, sensory regression or abnormality, hearing loss and tinnitus, etc. CNS: cognitive impairment, headache, epilepsy, hypersomnia, etc. | ①CIPN: 30–80% ②CICI: 69–78% | ①Drug dose dependence and accumulation ②Systemic administration ③Non-specific toxicity ④Cancer cell drug resistance ⑤Persistence of drug toxicity ⑥Patient’s physical condition requirements | ①Alternative chemotherapy regimens or drug dose control ②Neurotransmitter and hormone-related drugs ③Neuroprotective drugs ④Sensory-motor training ⑤Compression or cryotherapy ⑥CBPT |
Chronic | Partially irreversible | ||||||||
Delayed | Essentially irreversib | ||||||||
Immunotherapy | Immune- mediated injury | Acute | Reversible | ①Immune cell over-infiltration ②Immune-mediated inflammatory response | ①Clinical symptoms and signs ②Regular swallowing and breathing tests ③Imaging evaluation ④CK and neurobiomarker detection ⑤Multidisciplinary discussion | PNS: GBS, cranial nerve injury, neuromuscular diseases, etc. CNS: hypophysitis, encephalitis, aseptic meningitis, etc. | ①Overall incidence rate: 1–5% ②GBS: 0.2–0.4% | ①Immune-related adverse events ②High interindividual variability in treatment efficacy ③Complexity of combined therapy ④Limitations of biomarkers ⑤Limitations of applicable cancer types | ①Corticosteroids ②Immunoglobulin or plasma exchange ③Discontinuation or substitution of the drug ④Symptomatic and Supportive Treatment |
Subacute | Partially reversible | ||||||||
Chronic | Partially irreversible | ||||||||