Radiation-Induced Brachial Plexopathy in Breast Cancer and the Role of Surgical Treatment
Objective We aimed to evaluate improvement in the pain, motor, and sensory functions after neurosurgical intervention, by objective methods in patients with radiation-induced brachial plexopathy (RIBP), as a complication of radiotherapy (RT).
Materials and Methods In our study, 11 patients, who experienced grade 3 or 4 brachial plexopathy according to the LENT-SOMA (late effects of normal tissue—subjective, objective, management, analytic) side-effect index, as a complication of RT which was performed after being operated for breast cancer, were included. In the postoperative period pain, sensation, and motor function loss were followed.
Results There was apparent regression in the pain. The mean visual analogue scale (VAS) value decreased to 4 from the preoperative VAS value of 9.4. However, no significant improvement was observed in either sensory and motor functions.
Conclusion RIBP is a progressive disease in breast cancer patients after radiotherapy. Evaluation of the results of applied surgical treatments and changes in the results with time is important to direct the treatment. Neurolysis should only be considered when other treatment methods fail and should be considered as an irreversible and potentially permanent procedure.
26 August 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Stoll BA, Andrews JT. Radiation-induced peripheral neuropathy. BMJ 1966; 1 (5491) 834-837
- 2 Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J 2018; 36 (02) 85-94
- 3 Cai Z, Li Y, Hu Z. et al. Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study. Oncotarget 2016; 7 (14) 18887-18895
- 4 Dropcho EJ. Neurotoxicity of radiation therapy. Neurol Clin 2010; 28 (01) 217-234
- 5 Yan M, Kong W, Kerr A, Brundage M. The radiation dose tolerance of the brachial plexus: a systematic review and meta-analysis. Clin Transl Radiat Oncol 2019; 18: 23-31
- 6 Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: current advances and future directions. Int J Med Sci 2012; 9 (03) 193-199
- 7 Coulier B, Van Cutsem O, Mailleux P, Richelle F. Brachial metastatic plexopathy as the inaugural manifestation of lung cancer: multimodality imaging. BJR Case Rep 2016; 2 (04) 20150410
- 8 Delanian S, Lefaix JL, Pradat PF. Radiation-induced neuropathy in cancer survivors. Radiother Oncol 2012; 105 (03) 273-282
- 9 Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol 2015; 141 (11) 1985-1994
- 10 Giuranno L, Ient J, De Ruysscher D, Vooijs MA. Radiation-induced lung injury (RILI). Front Oncol 2019; 9: 877
- 11 Skandarajah AR, Mann GB. Do all patients require radiotherapy after breast-conserving surgery?. Cancers (Basel) 2010; 2 (02) 740-751
- 12 Niehoff P, Hey-Koch S. Lymph node radiotherapy instead of extended axillary surgery—the new standard?. Breast Care (Basel) 2018; 13 (03) 173-175
- 13 Al-Benna S, Schubert C, Steinau HU, Steinstraesser L. Brachial neuropathy 22 years after radiation therapy for fibrosarcoma: a case report. Cases J 2009; 2: 6838
- 14 Giglio P, Gilbert MR. Neurologic complications of cancer and its treatment. Curr Oncol Rep 2010; 12 (01) 50-59
- 15 Torres C, Mailley K, Del Carpio O’Donovan R. MRI of the brachial plexus: modified imaging technique leading to a better characterization of its anatomy and pathology. Neuroradiol J 2013; 26 (06) 699-719
- 16 Fan YL, Othman MI, Dubey N, Peh WC. Magnetic resonance imaging of traumatic and non-traumatic brachial plexopathies. Singapore Med J 2016; 57 (10) 552-560
- 17 Mansukhani KA. Electrodiagnosis in traumatic brachial plexus injury. Ann Indian Acad Neurol 2013; 16 (01) 19-25
- 18 Fan H, Kim SM, Cho YJ, Eo MY, Lee SK, Woo KM. New approach for the treatment of osteoradionecrosis with pentoxifylline and tocopherol. Biomater Res 2014; 18: 13
- 19 Fallon MT. Neuropathic pain in cancer. Br J Anaesth 2013; 111 (01) 105-111
- 20 Ding Y, Yao P, Li H. et al. CT-guided stellate ganglion pulsed radiofrequency stimulation for facial and upper limb postherpetic neuralgia. Front Neurosci 2019; 13: 170
- 21 Nabil Abbas D, Abd El Ghafar EM, Ibrahim WA, Omran AF. Fluoroscopic stellate ganglion block for postmastectomy pain: a comparison of the classic anterior approach and the oblique approach. Clin J Pain 2011; 27 (03) 207-213
- 22 Narakas AO. Operative treatment for radiation-induced and metastatic brachial plexopathy in 45 cases, 15 having an omentoplasty. Bull Hosp Jt Dis Orthop Inst 1984; 44 (02) 354-375
- 23 Nicoson MC, Franco MJ, Tung TH. Donor nerve sources in free functional gracilis muscle transfer for elbow flexion in adult brachial plexus injury. Microsurgery 2017; 37 (05) 377-382
- 24 Michael MH, Charles EA. Permanent Neural Blockade and Chemical Ablation in Pain Management Secrets. 3rd ed. 2009
- 25 Hems T. Nerve transfers for traumatic brachial plexus injury: advantages and problems. J Hand Microsurg 2011; 3 (01) 6-10