Radiation-Induced Brachial Plexopathy in Patients With Breast Cancer Treated With Comprehensive Adjuvant Radiation Therapy

Rudra, Soumon; Roy, Amit; Brenneman, Randall; Gabani, Prashant; Roach, Michael C.; Ochoa, Laura; Prather, Heidi; Appleton, Catherine M.; Margenthaler, Julie A.; Peterson, Lindsay L.; Bagegni, Nusayba A.; Zoberi, Jacqueline E.; Garcia-Ramirez, José; Thomas, Maria; Zoberi, Imran

doi:10.1016/j.adro.2020.10.015

Cited by 12 publications

(23 citation statements)

References 16 publications

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“…Il trattamento della regione sovraclaveare con dosi elevate di radioterapia può causare alterazioni al plesso brachiale (plessopatia brachiale post-attinica) [153][154] . L'incidenza di tale complicanza è compresa tra lo 0% ed il 5% ed è correlata alla dose totale, al frazionamento adottato ed al volume di plesso brachiale incluso 155 .…”

Section: (E) Plessopatia Brachialeunclassified

“…I sintomi insorgono lentamente; se non diagnosticati e seguiti con terapie adeguate di supporto possono comportare ipostenia, contratture muscolari crampiformi, ipotrofia muscolare. I sintomi della plessopatia post attinica possono indurre ritardi nella diagnosi differenziale, con eventuali recidive che coinvolgono le radici del plesso brachiale [156][157][158]167 .…”

Section: (E) Plessopatia Brachialeunclassified

“…Il rischio è maggiore con dosi superiori ai 50 Gy ed in associazione con trattamenti chemioterapici [156][157] . Attualmente è una complicanza di rara comparsa grazie alle tecniche innovative di RT ed allo sviluppo del piano dosimetrico in 3D che ha il controllo tridimensionale della dose delle strutture a rischio incluse nell'area di trattamento [153][154] .…”

Section: (E) Plessopatia Brachialeunclassified

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AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Ciabattoni

Gregucci

Rose

et al. 2022

Tumori

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Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.

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Section: (E) Plessopatia Brachialeunclassified

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AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Ciabattoni

Gregucci

Rose

et al. 2022

Tumori

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“…3,7 Chronic progressive weakness is typical, without neuropathic pain or sensory symptoms, and no cure is currently available. [3][4][5][6][7][8][9] The pathogenic mechanism behind chronic postradiation neurologic complications is believed to relate to microvascular injury from the radiation exposure leading to fibrosis in both neural and non-neural tissues. 9 The specific role inflammation plays in this process is unclear in the peripheral nervous system, but subacute-onset inflammation and angiogenesis have been reported in radiation-induced necrosis of the brain.…”

Section: Introductionmentioning

confidence: 99%

Clinical, Neurophysiologic, and Pathologic Features in Patients With Early-Onset Postradiation Neuropathy

et al. 2023

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Objective:To study early-onset radiation-induced neuropathy reviewing neurologic course, steroid-response, and available nerve biopsies.Methods:Patients coded with radiation-induced neuropathy within six-months of radiation were reviewed from January 1st,1999-August 31st, 2022. Patients had to have electrodiagnostically confirmed neuropathy localized within or distal to radiation fields. Neurological course and nerve biopsies were reviewed.Results:Twenty-eight patients (16 males and 12 females, mean age 63.8 years) were identified. Average radiation dose was 4659cGy (range 1000-7208). Tumor infiltration was not observed on MRI and PET. Post radiation onsets averaged 2 months (range 0-5). Localizations included brachial (n=4) plexopathies, lumbosacral (n=12) plexopathies, radiculopathies (n=10), and mononeuropathies (n=2). Neuropathic pain (n=25) and weakness (n=25) were typical. The clinical courses were subacute monophasic (n=14), chronic progressive (n=8) or static (n=1), and 5 were without follow-up. Nerve biopsies (n=8) showed an inflammatory ischemic process with perivascular inflammatory infiltrates (n=7) or microvasculitis (n=2). Nine patients, 7 with monophasic courses, received steroid burst therapy with symptom improvement in 8. No patients recovered entirely back to baseline.Discussion:In contrast to chronic radiation induced neuropathy early-onset patients most commonly have painful, monophasic courses with residual deficits, possibly steroid responsive. An ischemic inflammatory pathogenesis is suggested.

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“… 11 Total Body Irradiation and Total Skin Irradiation Techniques in Belgium and the Netherlands: Current Clinical Practice 11 Koken, P.; Murrer, L. 12 The Hippocampus: A New Organ at Risk for Postoperative Radiation Therapy for Bucco-alveolar Cancer? A Dosimetric and Biological Analysis 12 Nangia, S.; Singh, M.; Khosa, R.; Rout, S.; Singh, G.; Oomen, S. 13 Ablative Five-Fraction Stereotactic Body Radiation Therapy for Inoperable Pancreatic Cancer Using Online MR-Guided Adaptation 13 Hassanzadeh, C.; Rudra, S.; Bommireddy, A.; Hawkins, W.; Wang-Gillam, A.; Fields, R.; Cai, B.; Park, J.; Green, O.; Roach, M.; Henke, L.; Kim, H. 14 Genomically Guided Breast Radiation Therapy: A Review of the Current Data and Future Directions 14 Liveringhouse, C.; Washington, I.; Diaz, R.; Jimenez, R.; Harris, E.; Rabinovitch, R.; Woodward, W.; Torres-Roca, J.; Ahmed, K. 15 Residency Match Trends, Racial Disparity, and Matching Amid a Pandemic 15 Vassantachart, A.; Hwang, L.; Vassantachart, A.; Jennelle, R. 16 Radiation-Induced Brachial Plexopathy in Patients With Breast Cancer Treated With Comprehensive Adjuvant Radiation Therapy 16 Rudra, S.; Roy, A.; Brenneman, R.; Gabani, P.; Roach, M.; Ochoa, L.; Prather, H.; Appleton, C.; Margenthaler, J.; Peterson, L.; Bagegni, N.; Zoberi, J.; Garcia-Ramirez, J.; Thomas, M.; Zoberi, I. 17 A Review and Analysis of Managing Commonly Seen Implanted Devices for Patients Undergoing Radiation Therapy 17 Chan, M.; Young, C.; Gelblum, D.; Shi, C.; Rincon, C.; Hipp, E.; Li, J.; Wang, D. 18 Current Social Media Use Among Radiation Oncology Trainees 18 Albert, A.; Kahn, J.; Knoll, M.; Lirette, S.; Yechieli, R.; Gerber, N.; Jagsi, R.; Katz, M. 19 A Comparison of Predicted Ipsilateral Tumor Recurrence Risks in Patients With Ductal Carcinoma in Situ of the Breast After Breast-Conserving Surgery by Breast Radiation Oncologists, the Van Nuys Prognostic Index, the Memorial Sloan Kettering Cancer Center DCIS Nomogram, and the 12-Gene DCIS Score Assay 19 Lei, R.; Carter, D.; Antell, A.; Nowels, M.; Tole, S.; Bennett, J.; Turner, M.; Baehner, F.; Leonard, C. 20 Stereotactic Versus Conventional Radiation Therapy for Patients With Pancreatic Cancer in the Modern Era 20 Abi Jaoude, J.; Thunshelle, C.; Kouzy, R.; Nguyen, N.; Lin, D.; Prakash, L.; Bumanlag, I.; Noticewala, S.; Niedzielski, J.; Beddar, S.; Ludmir, E.; Holliday, E.; Das, P.; Minsky, B.; Herman, J.; Katz, M.; Koong, A....…”

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confidence: 99%