Radiation-induced Brachial Plexus Injury After Radiotherapy for Nasopharyngeal Carcinoma

Abstract

Objective: Radiation-induced brachial plexus injury is a devastating complication that occurs after radiotherapy in the vicinity of the brachial plexus. Nasopharyngeal carcinoma, the most common type of cancer in Guangdong Province, is primarily treated with radiotherapy with subsequent side effects. However, radiation-induced brachial plexus injury is rarely reported in nasopharyngeal carcinoma. To draw attention to this correlation, we analyzed the clinical characteristics including the imaging findings of 10 patients suffering from radiation-induced brachial plexus injury for nasopharyngeal carcinoma. Methods: We considered the patients' medical histories, analyzed their clinical characteristics, and monitored the long-term efficacy of treatment. Results: The total irradiation dose of the nasopharynx ranged from 66.6 to 74 Gy, and that of the supraclavicular fossa ranged from 60 to 70 Gy. The mean latency was 8.2 + 5.5 years. Seven patients initially complained of bilateral weakness, and three patients complained of isolated pain. The injuries of eight patients reached Grade 3 or worse. Magnetic resonance imaging showed a low signal on T 1 -weighted images and a high signal on short tau inversion recovery sequences in all cases. Swollen nerve fibers were clearly displayed in magnetic resonance diffusion tensor imaging. Electromyography showed myokymia in three patients. With conservative therapy, only one patient was temporarily relieved of pain, while the conditions of others were not ameliorated. Conclusions: Radiation-induced brachial plexus injury is a late but catastrophic complication in patients with nasopharyngeal carcinoma. Clinicians should be aware of radiation-induced brachial plexus injury when deciding on treatment and should give them regular follow-up post radiotherapy.

Structure–Function Decoupling: A Novel Perspective for Understanding the Radiation-Induced Brain Injury in Patients With Nasopharyngeal Carcinoma

“…Our findings of structure–function decoupling in the bilateral insula and midbrain tegmentum [covering the periaqueductal gray matter (PAG)] may be related to the abnormal encoding of pain intensity, impaired inhibition of nociceptive inputs, and augmented pain perception ( Ossipov et al, 2014 ; Watson, 2016 ; Zhang et al, 2020b ). In fact, chronic headache and oral and neuropathic pain are common clinical symptoms in patients with RT-induced injury ( Gu et al, 2014 ; Hu et al, 2018 ), and we speculate that our findings of altered ReHo/VBM in the insula and PAG may be a central response to RT-induced peripheral nociceptive stimuli. Unfortunately, the detailed data related to cognition, autonomic nervous system (ANS) function, sleep quality, as well as pain rating were not available for the patients with NPC in this study.…”

Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy

“…Because NPC is highly radiosensitive, radiotherapy (RT) serves as the most efficient treatment, with the 5-year survival rate above 50% 3 . However, late complications, such as those reported in our previous work (optic neuropathy, brachial plexus injury and brain necrosis) 4 – 6 , have shown an increasing problem for RT treatment of NPC. While commonly used to prevent nodal metastasis, RT contributes to atherosclerosis of the irradiated vessels and increases the risk of vascular stenosis, which may lead to transient ischemic attacks (TIA) or ischemic stroke 7 .…”

Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study

“…Although Vitamin B group and neurotrophic therapy, e.g. gangliosides, may improve the general outcome of patients with peripheral nerve injury or diseases, no considerable evidence indicates benefit for RIBP [ 35 , 36 ]. Surgical intervention is unnecessary for treating RIBP in most cases, owing to a relative rarity of radiation-induced fibrosis surrounding the plexus.…”