PURPOSE: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. METHODS AND MATERIALS: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. RESULTS: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. CONCLUSION: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.
PURPOSE: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. METHODS AND MATERIALS: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. RESULTS: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. CONCLUSION: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.
Authors: Joris Van de Velde; Tom Vercauteren; Werner De Gersem; Johan Wouters; Katrien Vandecasteele; Philippe Vuye; Frank Vanpachtenbeke; Katharina D'Herde; Ingrid Kerckaert; Wilfried De Neve; Tom Van Hoof Journal: Strahlenther Onkol Date: 2014-04-09 Impact factor: 3.621
Authors: Natalie Pattison; Matthew Rd Brown; Anthony Gubbay; Janet Peacock; Joy R Ross; Suzanne Chapman; Odile Sauzet; John Williams Journal: Br J Pain Date: 2015-09-23
Authors: Bindu V Manyam; Kyle Verdecchia; Kevin Rogacki; Chandana A Reddy; Tingliang Zhuang; Gregory M M Videtic; Joseph T Azok; Kevin L Stephans Journal: J Radiosurg SBRT Date: 2019
Authors: Guillaume Lamotte; Elizabeth A Coon; Mariana D Suarez; Paola Sandroni; Eduardo E Benarroch; Jeremy K Cutsforth-Gregory; Michelle L Mauermann; Sarah E Berini; Kamal Shouman; David Sletten; Brent P Goodman; Phillip A Low; Wolfgang Singer Journal: Neurology Date: 2021-05-04 Impact factor: 11.800