Dosevolume modeling of brachial plexusassociated neuropathy after radiation. Treatment technique, radiation volume and concomitant use of chemotherapy are associated with development of radiation injury to the brachial plexus. Compared with tumourrelated plexopathy, radiation damage to the brachial plexus seems to cause less severe pain, and is initially distributed in the upper division of the brachial. We analyzed the usefulness of a symptom questionnaire to screen for radiation induced brachial plexopathy ribp after breast cancer treatment. Thirtyonepatients with ribp after radiotherapy for npc were enrolled.
Trauma may be a direct blow or traction or stretch injury. Radiationinduced brachial plexopathy lymphedema blog. Delayed radiation injury to the brachial plexus is one of the common causes of nontrau matic brachial plexopathy in previously treated cancer patients 1, 2. Radiationinduced brachial plexopathy ribp is caused by radiation damage to the brachial plexus, a bundle of nerves located near the neck and shoulder. The incidence is more commonly reported following radiation. The frequency of radiationinduced brachial plexopathy has declined over the past 60 years and depends significantly on both the radiation dose and the proximity of the radiation volume to the underlying plexus.
Radiationinduced lumbar plexopathy rilp or radiation induced lumbosacral plexopathy rilsp is nerve damage in the pelvis and lower spine area occurring as a late side effect of external beam radiation therapy. To study the clinical presentation and natural history of radiationinduced brachial plexopathy in 33 women treated for carcinoma of the breast methods. In general terms, such nerve damage may present in stages, earlier as demyelination and later as complications of chronic radiation. Radiation induced brachial plexopathy ribp what is that. Radiation therapy to the chest, neck or axillary region for the underlying tumor may result in brachial plexopathy. Radiationinduced brachial plexopathy thieme connect. It may result from medical conditions and from violent stretching. Radiation induced brachial plexopathy ribpa disorder characterized by numbness, pain, paresthesia and motor deficit 5 may develop if the tolerance dose of the brachial plexus is exceeded. To describe the mr imaging appearance of radiation induced brachial plexopathy. This is a rare sideeffect of radiation treatment for breast cancer that affects approximately 1 percent of breast cancer patients. The brachial plexus, which is the most complex structure of the peripheral nervous system, supplies most of the upper extremity and shoulder. Radiation induced brachial plexopathy stepupspeakout. Mr imaging was performed in two patients with the clinical diagnosis of radiation induced brachial plexopathy and in one with surgically proven radiation fibrosis of the brachial.
Electrodiagnosis of brachial plexopathies and proximal. Radiationinduced lumbosacral plexopathy can result when radiation, used in the treatment of various neoplasms, is directed toward management of abdominal and pelvic malignancies i was diagnosed with a blood cancer called multiple myeloma mm in early 1994. The first reports of radiation induced brachial plexopathy appeared in the early 1960s shortly after the widespread introduction of modern megavoltage radiotherapy for treatment of breast carcinoma. The region of nerves it affects are at the brachial or lumbosacral plexus. This irb approved study included 68 patients with hnscc treated consecutively. In patients with cancer and plexopathy following radiation therapy. Pdf radiationinduced brachial plexopathy in patients with. Radiationinduced brachial plexopathy in women treated for. The clinical diagnosis is confirmed by electrodiagnostic studies emg.
The clinical description of rbp is hampered by the heterogeneity of the patient materials and great variation in radiation. Radiationinduced brachial plexus neuropathy in breast. Radiation induced brachial plexus neuropathy ribpn is an uncommon problem. Radiationinduced brachial plexopathy differential diagnoses. Current radiation treatment oncology group recommendations for head and neck cancer recommend doses below 6066 gy for the brachial plexus. Detailed dose volume histogram data was generated for ipsilateral and contralateral brachial. Metastatic brachial plexopathy in breast cancer kannan et. Symptoms include pain, loss of motor control, and sensory deficitsboth plexopathies can also occur as a consequence of radiation. Radiation induced brachial plexopathy ribp the following is the full text of this portion of the royal college report. Radiationinduced brachial plexopathy in patients with nasopharyngeal carcinoma. Radiationinduced brachial plexopathy, especially the chronic and progressive form, has become an increasingly rare entity in patients receiving radiation. Distinction between neoplastic and radiationinduced brachial. The higher the radiation dose, the higher the risk of developing a radiation induced brachial plexopathy.
Management of radiationinduced brachial plexus neuropathy. Radiationinduced brachial plexopathy ribp the following is the full text of this portion of the royal college report. Article radiationinduced brachial plexopathy applied radiology. Pain is present initially in only 10% of patients, although ultimately it is noted in as many as 50% of patients. Radiation induced brachial plexopathy ribp is one of the late complications in nasopharyngeal carcinoma npc patients who received radiotherapy.
It is a delayed nontraumatic brachial plexus neuropathy following radiation treatment for carcinomas in the region of neck, axilla, and chest wall. Radiation therapy is a well proven effective treatment modality in the management of various cancers. The current brachial plexopathy incidence is 12% in patients receiving a typical dose of less than 55 gy 2. Radiationinduced brachial plexopathy semantic scholar. Radiationinduced brachial plexus neuropathy ribpn is a delayed nontraumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, andor axilla in previously treated patients with cancer. However, radiation therapy has potentially adverse effects on several tissues including central and peripheral nervous systems. The clinical description of rbp is hampered by the heterogeneity of the patient materials and great variation in radiation doses 25. Radiationinduced brachial plexus neuropathy ribpn is an uncommon problem. Radiationinduced brachial plexopathy in patients with. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery setups.
It is defined as the neurologic impairment of transient or permanent nature involving the brachial plexus as a sequel to radiation. Plexopathy plexopathy is a disorder affecting a network of nerves, blood vessels, or lymph vessels. Charlotte lives with a condition called radiation induced brachial plexopathy. It is reproduced, with permission, from management of adverse effects following breast radiotherapy. The incidence of radiation induced brachial plexopathy in women with breast carcinoma is 1. The incidence of initial pain is lower than that of brachial plexopathy. Lumbar plexopathy produces weakness, sensory loss, and reflex changes in the distribution of spinal segments l1l4. A 54yearold man had a slowly progressive bilateral brachial plexopathy 17 months after surgery and radiation ther apy for a stage iv supraglottic carcinoma. Nerve transfer for elbow flexion in radiation induced brachial plexopathy. Radiation induced lumbosacral plexophaty rilp is a rare but severe complication that has a considerable impact on quality of life. The symptomatology of radiationinduced brachial plexopathy is variable and can occur from 6 months to 20.
Brachial plexopathy is a neurologic affliction that causes pain or functional impairment or both of the ipsilateral upper extremity. Factors like radiation dose, technique and concomitant chemotherapy play a vital role in the brachial plexus injury. Microsoft powerpoint csm 2018 radiation induced brachial plexopathy author. Its occurrence is rare but increasing with improved long. Pdf radiationinduced brachial plexopathy ribp is one of the late complications in nasopharyngeal carcinoma npc patients who received. We aimed to study the radiation induced brachial plexopathy in patients with head and neck squamous cell carcinoma hnscc treated with sequential intensity modulated radiation therapy simrt. I sustained a number of multiple myeloma side effects radiationinduced lumbosacral plexopathy. Radiationinduced brachial plexopathy can occur when radiotherapy is directed at the chest, axillary region, thoracic outlet, or neck for the treatment of a myriad of neoplastic diseases. Brachial plexopathy causes weakness, sensory loss, and loss of tendon reflexes in body regions innervated by nerves in the c5t1 segmental distribution. The nerves forming the brachial plexus originate at the spinal cord in the neck and are responsible for the sensory and muscular innervation of the entire upper extremity. Radiation induced brachial plexopathy is caused by radiation damage to the brachial plexus, a network bundle of nerves located near the neck and shoulder. Brachial plexopathy is a rare condition that may occur due to numerous reasons most common among the patients with cancer are the radiation and metastasis. Radiation induced brachial plexopathy is most commonly a delayed syndrome, occurring from a few weeks to many years after radiation. The wellknown frequent form is radiationinduced brachial plexopathy ribp following breast cancer irradiation, while tumour recurrence is easier to discount.
Radiationinduced plexopathy, radiculopathy or myelopathy. Cancerrelated brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Radiation induced brachial plexopathy genetic and rare. Brachial plexopathy due to breast cancer metastasis. Brachial plexopathy causes, symptoms, diagnosis, treatment. Brachial plexopathy developed in 20 of 1117 women 1. Nerve damage is a littleknown side effect of radiation. Patients with radiation induced lumbosacral plexopathy most commonly present with painless weakness in 1 or both legs.
It is reproduced, with permission, from management of adverse effects following. Brachial plexopathy causes weakness, sensory loss, and loss. We conducted a retrospective study to investigate its clinical characteristics and risk factors. A patient questionnaire for radiationinduced brachial. A 54yearold man had a slowly progressive bilateral brachial plexopathy 17 months after surgery and radiation.
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