Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients?

Bajrovic, Amira; Rades, Dirk; Fehlauer, Fabian; Tribius, Silke; Hoeller, Ulrike; Rudat, Volker; Jung, H.; Alberti, Winfried

doi:10.1016/j.radonc.2004.03.005

Cited by 114 publications

(54 citation statements)

References 17 publications

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“…Nevertheless, radiation-induced brachial plexopathy has been described as a potentially debilitating and irreversible condition characterised by upper extremity paraesthesias, weakness and motor dysfunction [7][8][9]. Although most reports exist in anecdotal form, clinicians generally agree that total dose and fraction size are important.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Chen

Wh²,

Bq³

et al. 2011

BJR

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Objective: The preferential use of intensity-modulated radiotherapy (IMRT) over conventional radiotherapy (CRT) in the treatment of head and neck cancer has raised concerns regarding dose to non-target tissue. The purpose of this study was to compare dose-volume characteristics with the brachial plexus between treatment plans generated by IMRT and CRT using several common treatment scenarios. Method: The brachial plexus was delineated on radiation treatment planning CT scans from 10 patients undergoing IMRT for locally advanced head and neck cancer using a Radiation Therapy Oncology Group-endorsed atlas. No brachial plexus constraint was used. For each patient, a conventional three-field shrinking-field plan was generated and the dose-volume histogram (DVH) for the brachial plexus was compared with that of the IMRT plan. Results: The mean irradiated volumes of the brachial plexus using the IMRT vs the CRT plan, respectively, were as follows: V50 (18¡5 ml) vs (11¡6 ml), p50.01; V60 (6¡4 ml) vs (3¡3 ml), p50.02; V66 (3¡1 ml) vs (1¡1 ml), p50.04, V70 (0¡1 ml) vs (0¡1 ml), p50.68. The maximum point dose to the brachial plexus was 68.9 Gy (range 62.3-78.7 Gy) and 66.1 Gy (range 60.2-75.6 Gy) for the IMRT and CRT plans, respectively (p50.01). Conclusion: Dose to the brachial plexus is significantly increased among patients undergoing IMRT compared with CRT for head and neck cancer. Preliminary studies on brachial plexus-sparing IMRT are in progress.

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Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Chen

Wh²,

Bq³

et al. 2011

BJR

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“…No RIBP was observed after changes in the irradiation technique and lowering the total dose to the supraclavicular nodes to 49 Gy with 1.96 Gy per fraction in a group of 200 patients. Bajrovic et al [23] observed RIBP in 19 of 140 (14%) patients who were irradiated with 60 Co on supraclavicular field with a total dose 52 Gy with 2.6 Gy per fraction to the brachial plexus. Delouche et al [24] observed RIBP in 2 of 117 patients (1.7%) irradiated to the total given dose of 60 Gy in 2 Gy per fraction.…”

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confidence: 99%

Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review

et al. 2006

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“…Listed in Table 3 are selected published data on the rate of brachial plexus neuropathy (BPN) following differently fractionated radiation therapy of the breast and axillary ± supraclavicular regionpublished in the literature [1][2][3]9,13,14,[25][26][27][28][29][30][31][32][33], showing a low rate of high grade BPN, comparable as following normal-fractionation. According to an analysis included in the protocol of the START A trial, at least in some of those patients the dose per fraction, the total dose and the dose to the plexus were higher than the prescription dose.…”

Section: Discussionmentioning

confidence: 99%

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

Studer

Stocker²,

Ferdin³

et al. 2014

J Nucl Med Radiat Ther

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Aims: The use of hypo fractionated irradiation of the whole breast has regained much interest after the publication of the results of large randomized trials showing equivalent results as using standard fractionation (START A and B, randomized START pilot trials, Canadian trial). Due to the relatively low numbers of patients treated with hypofractionation to the supraclavicular ±axillary (S/A) region, the question of the brachial plexus tolerance continues to be discussed. Aim of this work was to assess the high grade long term tolerance of the brachial plexus in our patients treated with 13x 3.3Gy to the S/A lymph nodes, in order to contribute to the question of plexus tolerance. Materials and Methods: Between 1967 and 1977, 130 female breast cancer patients underwent postoperative hypo fractionated radiotherapy at the University Hospital Zurich. The most used schedule was 13x 3.3Gy midline dose, 3x/week (n=124) to the S/A region applied by equally rated antero-posterior/postero-anterior portals. A first assessment of the cohort was performed in 1994, which has been updated in December 2013. Patients with a follow up period <5 years or loco-regional disease have been excluded in 1994 (n=4, all without plexopathy). Pre-radiation surgery consisted of radical mastectomy in 98% and breast conserving operation in 2% of all patients, including axillary dissection. Pathological stage was pT1/2/3/4 in 28/58/10/4%; with pN0/pN+ in 57/43%. The mean/median follow up time of the cohort was 28.1/26.6 years (range, 7.2-44.8). Results: One grade 2 brachial plexus neuropathy was observed. Conclusion: The long term follow up in our patients corroborates the hypothesis of a total mid plane dose to the S/A region between 40-42Gy in 13 fractions being comparably safe as 25x 2.0Gy to 50Gy. AbstractAims: The use of hypo fractionated irradiation of the whole breast has regained much interest after the publication of the results of large randomized trials showing equivalent results as using standard fractionation (START A and B, randomized START pilot trials, Canadian trial). Due to the relatively low numbers of patients treated with hypofractionation to the supraclavicular ±axillary (S/A) region, the question of the brachial plexus tolerance continues to be discussed.Aim of this work was to assess the high grade long term tolerance of the brachial plexus in our patients treated with 13x 3.3Gy to the S/A lymph nodes, in order to contribute to the question of plexus tolerance. Between 1967 and 1977, 130 female breast cancer patients underwent postoperative hypo fractionated radiotherapy at the University Hospital Zurich. The most used schedule was 13x 3.3Gy midline dose, 3x/week (n=124) to the S/A region applied by equally rated antero-posterior/postero-anterior portals. A first assessment of the cohort was performed in 1994, which has been updated in December 2013. Patients with a follow up period <5 years or loco-regional disease have been excluded in 1994 (n=4, all without plexopathy). Pre-radiation surgery consisted o...

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Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients?

Cited by 114 publications

References 17 publications

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review

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

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