Radiation-induced brachial plexus injury: follow-up of two different fractionation schedules

Late Effects of Radiotherapy in the Treatment of Breast Cancer

“…It can be used as an example of how the incidence of late effects can be drastically increased by changes of the treatment parameters. The relation between the treatment schedule and BPL has been studied by several investigators (11,(16)(17)(18)(19)(20)(21). In a classic paper, Stoll & Andrews (16) found symptoms of brachial plexus neuropathy in 73% of patients who had been treated with approximately 55 Gy in the plexus but only in 15% if the dose was 51 Gy.…”

“…Unexpected late complications have been reported even if the acute reactions agreed with those expected from the formula. This shows that there is a dissociation between the intensity of acute reactions and late changes in different treatment schedules (11,12). The slope of the dose-effect relationship is steep, meaning that a small change in effective dose may cause a rapid increase of severe late effects (e.g.…”

Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy

“…82 The common side effects of fatigue and radiation dermatitis are generally transient and well-tolerated. The risks of brachial plexopathy 83,84 and rib fractures 85 are estimated at less than 2% in older series and are likely even lower with modern PMRT techniques. The risk of secondary neoplasms is also rare and does not constitute a contraindication to PMRT.…”

Constraining the Brachial Plexus Does Not Compromise Regional Control in Oropharyngeal Carcinoma

“…Recent modern studies have reported median times to onset of symptoms ranging from 6.5 months to 4 years from the completion of radiotherapy and ranges of 1.4 months to 26 years [2,3]. Once they develop, there may be a gradual evolution of symptoms or a more rapid progression with time, which may on occasion culminate in complete loss of function of the affected arm [1,4]. Treatment options for these patients remain inadequate, and prognosis is poor.…”

“…Treatment options for these patients remain inadequate, and prognosis is poor. Brachial plexopathy has been associated with greater cumulative radiation dose to the brachial plexus (BP), radiotherapy fraction size, maximum dose, as well as the addition of chemotherapy and neck dissection [1,2,[4][5][6]. One group recently used a validated symptom questionnaire in order to screen a large head-and-neck cancer population who had undergone radiation therapy.…”