Report on 42 Cases of Postirradiation Lesions of the Brachial Plexus and Their Treatment

Abstract

Here we report 42 cases of postirradiation lesions of the brachial nerve plexus in patients treated with radiotherapy after radical mastectomy. These lesions usually appeared at least 1 year after treatment, and motorial disturbances always developed, even if initially they may have been absent. A comparison of the case material indicates that a reduction in the dose administered to the supraclavicular region and exclusion of the axillary region from the treatment resulted in a significant reduction in the incidence of these lesions. In fact, in a group of 490 patients treated by the old radiotherapy method at the Istituto Nazionale Tumori of Milan (i.e., administration of 6000 rad to the brachial nerve plexus), 16 cases of lesions at this plexus were observed. In a group of 200 patients treated instead with a new method (i.e., administration of 4900 rad to the brachial nerve plexus and exclusion of the axillary region), no nerve lesions were observed, with significance levels, according to Fisher's test, less than 0.9%. Since radiolesions at the brachial nerve plexus have a very bad prognosis with regard to functioning of the limb and physiotherapy is of little help, this new therapeutic method is very useful, and it is not accompanied by an increase in the number of local recurrences as compared to the old method.

Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies

“…RIP typically presents as a painless lesion with paresthesia and numbness, and lesion of the lumbosacral plexus is associated with limb edema and bilateral involvement 13,15-17. In contrast to previous reports, our results showed that the rate of pain presenting with the first symptom was 50% (Table 3), which was higher than previous reports, and the development of limb edema was not significantly different between RIP and neoplastic plexopathy.…”

Neurological Manifestations of Neoplastic and Radiation-Induced Plexopathies

“…22 The clinical radiation plexopathy syndromes have been described more commonly than have true neoplastic plexopathy. 1,[3][4][5]16,[23][24][25][26][27][28][29] The overall frequency of radiation plexopathy in treated patients is 1.8 to 4.9%. [3][4][5] At 5-year follow-up, radiation plexopathy was diagnosed in 2% of patients with stage III breast cancer following treatment with 4500 to 5000 cGy to chest wall and lymphatics.…”

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

“…This confirmed the thesis that dose per fraction is an important risk factor for the development of plexopathy. Basso-Ricci et al [22] diagnosed RIBP in 16 of 490 patients (3.2%) in whom the total dose to the plexus was 60 Gy in 2 Gy per fraction. The technique used was characterized by a high risk of field overlap and a dose to the plexus higher than expected from the prescribed dose.…”