Lumbosacral plexopathy: A rare long term complication of concomitant chemo-radiation for cervical cancer

Abstract

Radiation induced Lumbosacral plexophaty (RILP) is a rare but severe complication that has a considerable impact on quality of life. Its occurrence is rare but increasing with improved long-term cancer survival. This entity commonly results in different degrees of sensory and motor deficits. The pathophysiological mechanisms are not yet fully understood. Diagnosis of radiation myelopathy in women with gynecologic malignancies may increase with the use of concomitant chemo-radiation. This report describes the effect of this combination therapy in a 64-year-old woman with cervical carcinoma.

Case report: radiation-induced lumbosacral plexopathy – a very late complication of radiotherapy for cervical cancer

“…Numerous risk factors associated with radiotherapy have been identified: large total dose (> 50 Gy to plexus), large dose per fraction (2.5 Gy), heterogeneous high-dose distribution, hot spot high dose, and using an intracavitary radium source [ 1 , 3 , 12 ]. Low-energy devices operated in the 1970s used a close source-to-skin distance, alternating treated fields with steep dosage gradients inside the body [ 1 ].…”

“…The first phase is characterised by alterations in the electrophysiology and histochemistry of neurons and glial cells; the second phase is characterised by fibrosis of the nerve-supporting tissue [ 11 , 13 ]. Recent studies also suggest that compression of nerves produced by severe indirect radiation-induced fibrosis is another essential factor [ 3 ]. Thus, the pathogenesis of RILP has not been fully explained; it is a kind of delayed local nerve tissue damage that is partially caused by early microvascular injury followed by radiation-induced fibrosis [ 1 ].…”

“…Sensory impairments together with neuropathic pain are typically discovered later. Symptoms are usually bilateral and asymmetric, with initial unilateral damage [ 1 , 3 , 14 ]. Our case fits this description; the disease manifested initially as bilateral and asymmetric lower extremity weakness, followed by sensory impairment and neuropathic pain.…”

“…Radiation therapy of the pelvic region is a crucial treatment for various types of cancer that occur in this area, most notably cervical carcinoma [ 2 ]. Although peripheral nervous system involvement following radiation therapy is uncommon, one such complication – radiation-induced lumbosacral plexopathy (RILP) – is the most frequent side effect and presents diagnostic and therapeutic challenges [ 3 ]. It is a permanent, incurable complication that typically manifests many years after radiation [ 3 ].…”

“…Although peripheral nervous system involvement following radiation therapy is uncommon, one such complication – radiation-induced lumbosacral plexopathy (RILP) – is the most frequent side effect and presents diagnostic and therapeutic challenges [ 3 ]. It is a permanent, incurable complication that typically manifests many years after radiation [ 3 ]. Previous studies have indicated that neurological issues may manifest up to 30 years following the irradiation [ 4 – 8 ].…”