title: Immune thrombocytopenia as a paraneoplastic syndrome in patients with nasopharyngeal cancer.
abstract: BACKGROUND
  Nasopharyngeal cancer (NPC) presenting with thrombocytopenia is rare. This report details 2 cases of NPC with grade III thrombocytopenia as a paraneoplastic syndrome.
  
  
  METHODS
  We present 2 cases of NPC in whom grade III thrombocytopenia was diagnosed concurrently at presentation. One patient underwent definitive intensity-modulated radiation therapy (IMRT) in combination with concurrent cetuximab, the other with cisplatin. Both patients received adjuvant chemotherapy composed of docetaxel and cisplatin.
  
  
  RESULTS
  The cause of their grade III thrombocytopenia was diagnosed as immunologic in origin. Prednisone was administered before IMRT, and their peripheral platelet counts recovered to normal levels. Their platelet counts fell below normal levels several times during their treatment. However, their radiotherapy and chemotherapy had never been interrupted due to thrombocytopenia.
  
  
  CONCLUSIONS
  Grade III thrombocytopenia is a rare paraneoplastic syndrome in patients with NPC. These patients can tolerate the aggressive definitive management of radiotherapy and chemotherapy with supportive care.
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Kunyu
authors.initials: K
authors.lastname: Yang
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Li
authors.initials: L
authors.lastname: Fan
authors.forename: Zhongyuan
authors.initials: Z
authors.lastname: Yin
authors.forename: Yu
authors.initials: Y
authors.lastname: Hu
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000188:drug therapy; D050397:Radiotherapy, Intensity-Modulated