A 68-year-old male patient presented with a week of sudden diplopia. He had been diagnosed with nasopharyngeal cancer 8 months prior and had undergone chemotherapy with radiotherapy. Eight-prism diopter right esotropia in the primary position and a remarkable limitation in abduction in his right eye were observed. Other pupillary disorders and lid drooping were not found. After three weeks, the marginal reflex distance 1 was 3 mm in the right eye and 5 mm in the left eye. The pupil diameter was 2.5 mm in the right eye, and 3 mm in the left eye under room illumination. Under darkened conditions, the pupil diameter was 3.5 mm in the right eye, and 5 mm in the left eye. After topical application of 0.5% apraclonidine, improvement in the right ptosis and reversal pupillary dilatation were observed. On brain magnetic resonance imaging, enhanced lesions on the right cavernous sinus, both sphenoidal sinuses, and skull base suggested the invasion of nasopharyngeal cancer. Lesions on the cavernous sinus need to be considered in cases of abducens nerve palsy and ipsilateral Horner's syndrome.
Abducens Nerve Diseases/*etiology ; Aged ; Carcinoma, Squamous Cell/complications/pathology/therapy ; Cavernous Sinus/pathology ; Combined Modality Therapy ; Horner Syndrome/*etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Nasopharyngeal Neoplasms/complications/pathology/therapy

OBJECTIVETo evaluate the efficacy of zoledronic acid combined with local radiotherapy for limited metastatic bone cancer.

METHODSForty-five patients with limited bone metastatic cancers were randomly divided into two groups: 23 in the combination group who received intravenously administration of zoledronic acid and local radiotherapy, the other 22 in the radiotherapy alone group who underwent local radiotherapy only.

RESULTSThe response rate of pain relief was 91.3% in the combination group versus 86.4% in the radiotherapy alone group, without statistically significant difference between two groups (P > 0.05). However, the recalcification rate was significantly higher in the combination therapy group (52.2%) than that in radiotherapy alone group (22.7% P < 0.01), and the proportion of patients with new bone metastasis formation was significantly lower in the combination group (13.0%) than that in the radiotherapy alone group (40.9%, P < 0.05). The common side-effects were transient pyrexia and nausea.

CONCLUSIONZoledronic acid combined with local radiotherapy is effective in relieving pain, improving bone recalcification and reducing the formation of new bone metastasis.

Adult ; Aged ; Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; complications ; drug therapy ; radiotherapy ; secondary ; Bone Regeneration ; drug effects ; Breast Neoplasms ; pathology ; Combined Modality Therapy ; Diphosphonates ; therapeutic use ; Female ; Humans ; Imidazoles ; therapeutic use ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Pain ; etiology ; Pain Management ; Radiotherapy