40/42Gy in 13 Fractions: A Safe Dose for the Brachial Plexus

Studer, Gabriela; Stocker, David Norbert; Ferdin, Karl; Loewenich,; Glanzmann, Christoph

doi:10.4172/2155-9619.1000168

Cited by 4 publications

(4 citation statements)

References 31 publications

(37 reference statements)

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“…In addition, four studies were excluded due to lack of quantitative data (Platteaux et al., 2010; Sood et al., 2018; Thomas et al., 2015; Truong et al., 2012). Finally, 30 studies were included in the systematic review (Figure 1) (Amini et al., 2012; Basso-Ricci et al., 1980; Brunelli and Brunelli, 1985; Cai et al., 2016; Chen et al., 2012; Eblan et al., 2013; Fardin et al., 1990; Fathers et al., 2002; Forquer et al., 2009; Gosk et al., 2007; Hoeller et al., 2004; Johansson et al., 2000; Kıbıcı et al., 2020; Killer and Hess, 1990; Ko et al., 2011; Kori et al., 1981; LeQuang, 1989; Lindberg et al., 2019; Merle et al., 1988; Metcalfe and Etiz, 2016; Mondrup et al., 1990; Morse et al., 2022; Narakas, 1984; Pierce et al., 1992; Powell et al., 1990; Studer et al., 2014; Teixeira et al., 2007; Warade et al., 2019; Wu et al., 2014; Yin et al., 2023). Figure 2 shows the distribution of the included studies based on the publication year.…”

Section: Resultsmentioning

confidence: 99%

“…This review showed that radiation-induced injuries typically involve the entire BP, which often results in patients experiencing pain as well as motor and sensory deficits at all levels of the BP. There is considerable variability in the time between radiation exposure and the onset of clinical symptoms, a range of 5.8–540 months, with an average span of 33 months (Lindberg et al., 2019; Studer et al., 2014).…”

Section: Discussionmentioning

confidence: 99%

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The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Shekouhi,

Gerhold,

Chim

2023

J Hand Surg Eur Vol

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This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss ( n = 323, 62%), followed by motor deficits ( n = 294, 56%) and neuropathic pain ( n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage ( n = 108, 6%), followed by neurolysis alone ( n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Shekouhi,

Gerhold,

Chim

2023

J Hand Surg Eur Vol

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“…Hypofractctionation >2.11 Gy/f may result in a higher risk for RICNP due to hot spots. RT-induced nerve damage is known for a potentially long latency till clinical appearance (19).…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Glanzmann

Yousefi

Loewenich

et al. 2015

Molecular and Clinical Oncology

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Abstract. Radiation-induced cranial nerve palsy (RICNP) is a severe long-term complication in patients with head and neck cancer following high-dose radiation therapy (RT). We present the case report of a patient with bilateral RICNP of the hypoglossal and vagus cranial nerves (XII/X) following postoperative RT in the era prior to the introduction of intensity-modulated RT (IMRT), and an analysis of our IMRT patient cohort at risk including the case of a XII RICNP. A total of 201 patients whose glosso-pharyngeal (IX), X and XII cranial nerves had been exposed to >65 Gy definitive IMRT in our institution between January, 2002 and December, 2012 with or without systemic therapy, were retrospectively identified. A total of 151 patients out of 201 fulfilling the following criteria were included in the analysis: Locoregionally controlled disease, with a follow-up (FU) of >24 months and >65 Gy exposure of the nerves of interest. So far, one of the assessed 151 IMRT patients at risk exhibited symptoms of RICNP after 6 years. The mean/median FU of the entire cohort was 71/68 months (range, 27-145). The results were compared with literature reports. In conclusion, RICNP appears to be a rare complication. However, a longer FU and a larger sample size are required to draw reliable conclusions on the incidence of RICNP in the era of IMRT.

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“…show the collection of clinical data for brachial plexus. The SBRT data are obtained from(Forquer et al 2009, Benedict et al 2010, Emami 2013, Sood et al 2018, Timmerman 2022, HFRT data from(Stoll and Andrews 1966, Svensson et al 1975, Salner et al 1981, Barr and Kissin 1987, Powell et al 1990, Miller et al 1998, Johansson et al 2002, Bajrovic et al 2004, Studer 2014, Timmerman 2022 and CFRT data are obtained from the following (Basso-Ricci et al 1980, Powell et al 1990, Amini et al 2012, Truong et al 2012, Eblan et al 2013, Emami 2013, Chen et al 2014, Lundstedt et al 2015, Thomas et al 2015, Metcalfe and Etiz 2016, Yahya et al 2016, Yang et al 2016, Yathiraj et al 2016, Timmerman 2022). Some of the selected clinical data above are also available in Yan et al (2019) (see table 2A and table 2B in Yan et al (2019)).…”

mentioning

confidence: 99%

Obtaining organ-specific radiobiological parameters from clinical data for radiation therapy planning of head and neck cancers

Quashie,

Li,

Prior

et al. 2023

Phys. Med. Biol.

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Objective. Different radiation therapy (RT) strategies, e.g., conventional fractionation RT (CFRT), hypofractionation RT (HFRT), stereotactic body RT (SBRT), adaptive RT, and re-irradiation are often used to treat head and neck (HN) cancers. Combining and/or comparing these strategies requires calculating biological effective dose (BED). The purpose of this study is to develop a practical process to estimate organ-specific radiobiologic model parameters that may be used for BED calculations in individualized RT planning for HN cancers. Approach. Clinical dose constraint data for CFRT, HFRT and SBRT for 5 organs at risk (OAR) namely spinal cord, brainstem, brachial plexus, optic pathway, and esophagus obtained from literature were analyzed. These clinical data correspond to a particular endpoint. The linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) models were used to fit these clinical data and extract relevant model parameters (alpha/beta ratio, gamma/alpha, dT and BED) from the iso-effective curve. The dose constraints in terms of equivalent physical dose in 2Gy-fraction (EQD2) were calculated using the obtained parameters.Main results. The LQ-L and LQ models fitted clinical data well from the CFRT to SBRT with the LQ-L representing a better fit for most of the OARs. The alpha/beta values for LQ-L (LQ) were found to be 2.72 (2.11)Gy, 0.55 (0.30)Gy, 2.82 (2.90)Gy, 6.57 (3.86)Gy, 5.38 (4.71)Gy, and the dose constraint EQD2 were 55.91 (54.90)Gy, 57.35 (56.79)Gy, 57.54 (56.35)Gy, 60.13 (59.72)Gy and 65.66 (64.50)Gy for spinal cord, optic pathway, brainstem, brachial plexus, and esophagus, respectively. Additional two LQ-L parameters dT were 5.24Gy, 5.09Gy, 7.00Gy, 5.23Gy, and 6.16Gy, and gamma/alpha were 7.91, 34.02, 8.67, 5.62 and 4.95. Significance. A practical process was developed to extract organ-specific radiobiological model parameters from clinical data. The obtained parameters can be used for biologically based radiation planning such as calculating dose constraints of different fractionation regimens.

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40/42Gy in 13 Fractions: A Safe Dose for the Brachial Plexus

Cited by 4 publications

References 31 publications

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Obtaining organ-specific radiobiological parameters from clinical data for radiation therapy planning of head and neck cancers

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