Allen M Chen1, Pin-Chieh Wang2, Megan E Daly3, Jing Cui3, William H Hall3, Srinivasan Vijayakumar4, Theodore L Phillips3, D Gregory Farwell5, James A Purdy3. 1. Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. Electronic address: amchen@mednet.ucla.edu. 2. Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. 3. Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California. 4. Department of Radiation Oncology, University of Mississippi School of Medicine, Jackson, Mississippi. 5. Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Comprehensive Cancer Center, Sacramento, California.
Abstract
PURPOSE: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. METHODS AND MATERIALS: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered 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 radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. RESULTS: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose-volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). CONCLUSIONS: Dose-volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.
PURPOSE: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. METHODS AND MATERIALS: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered 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 radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. RESULTS: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose-volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). CONCLUSIONS: Dose-volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.
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: Emanuelle do Nascimento Santos Lima; Isabela Borges Ferreira; Paula Philbert Lajolo; Carlos Eduardo Paiva; Yara Cristina de Paiva Maia; Geórgia das Graças Pena Journal: Health Qual Life Outcomes Date: 2020-09-16 Impact factor: 3.186