The radiation dose tolerance of the brachial plexus: A systematic review and meta-analysis

Yan, Michael; Kong, Weidong; Kerr, A; Brundage, Michael

doi:10.1016/j.ctro.2019.06.006

Cited by 34 publications

(34 citation statements)

References 48 publications

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“…Brachial plexus dose tolerance for conventional fractionation has been studied (5,(33)(34) and contouring guidelines are available (2,(35)(36). The Emami limit for brachial plexus of EQD2 = 60Gy (5) corresponds to 26 Gy in 3 fractions, which is remarkably the same dose limit as recommended in the Indiana study (1).…”

Section: Discussionmentioning

confidence: 92%

Estimating the Tolerance of Brachial Plexus to Hypofractionated Stereotactic Body Radiotherapy – A Modelling-based Approach from Clinical Experience.

Kapitanova¹,

Biswas

Divekar

et al. 2020

Preprint

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Background: Brachial plexopathy (BP) is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose-response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor.Methods: Two published SBRT datasets were pooled and modeled from patients treated with SBRT at Indiana University and the Richard Roudebush VAMC from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) and a probit dose response model was created with maximum likelihood parameter fitting.Results: This analysis includes a total of 89 brachial plexus Dmax values from both institutions. Among the 14 patients who developed BP, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1-72.2) in the Karolinska dataset, and Indiana had a median of 13 months (range 1-71). Both studies had a median range of 3 fractions, but in the Indiana dataset 9 patients were treated in 4 fractions and the paper did not differentiate which ones were which, so our analysis is considered to be in 3-4 fractions, which is one of the main limitations. The probit model showed that the risk of BP with Dmax of 26 Gy in 3-4 fractions is 10%, and 50% with Dmax of 70 Gy in 3 -4 fractions.Conclusions: This analysis is only a preliminary result because more details are needed, and more comprehensive datasets are needed from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance.

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Section: Discussionmentioning

confidence: 92%

Estimating the Tolerance of Brachial Plexus to Hypofractionated Stereotactic Body Radiotherapy – A Modelling-based Approach from Clinical Experience.

Kapitanova¹,

Biswas

Divekar

et al. 2020

Preprint

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“…The data in the literature are mostly related with the prevention methods and conservative approaches. 5 In our study, 11 patients who did not show any improvement with conservative treatment and operated for RIBP were presented. Pain, sensory, and loss of motor functions were investigated, and the results were evaluated with the clinical examination indices.…”

Section: Introductionmentioning

confidence: 81%

Radiation-Induced Brachial Plexopathy in Breast Cancer and the Role of Surgical Treatment

Kıbıcı

Erok²,

Atça

2020

Indian Journal of Neurosurgery

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Objective We aimed to evaluate improvement in the pain, motor, and sensory functions after neurosurgical intervention, by objective methods in patients with radiation-induced brachial plexopathy (RIBP), as a complication of radiotherapy (RT). Materials and Methods In our study, 11 patients, who experienced grade 3 or 4 brachial plexopathy according to the LENT-SOMA (late effects of normal tissue—subjective, objective, management, analytic) side-effect index, as a complication of RT which was performed after being operated for breast cancer, were included. In the postoperative period pain, sensation, and motor function loss were followed. Results There was apparent regression in the pain. The mean visual analogue scale (VAS) value decreased to 4 from the preoperative VAS value of 9.4. However, no significant improvement was observed in either sensory and motor functions. Conclusion RIBP is a progressive disease in breast cancer patients after radiotherapy. Evaluation of the results of applied surgical treatments and changes in the results with time is important to direct the treatment. Neurolysis should only be considered when other treatment methods fail and should be considered as an irreversible and potentially permanent procedure.

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“…Radiation-induced brachial plexopathy is a rare manifestation of radiation therapy. While this is seen most commonly in patients who have been treated with radiation to the region of the plexus for breast cancer, it may also occur following treatment for other head and neck, lung, or metastatic cancer from distant neoplasms to lymph nodes in the shoulder ( Yan et al, 2019 ). Less than 5–9% of patients treated with radiation develop brachial plexopathy following radiation ( Emami et al, 1991 , Mondrup et al, 1990 ).…”

Section: The Brachial Plexusmentioning

confidence: 99%

“…Several factors have been associated with an increased risk of development of brachial plexopathy, the most important being the dose of radiation. A meta-analysis of studies assessing the risk of radiation brachial plexopathy relative to the radiation dose found that the radiation dose was ≤6000 cGy in 62.5% of studies that reported <5% incidence of radiation plexopathy, and ≤6600 cGy in 75% of the studies with the same incidence ( Yan et al, 2019 ). Thus, maximum radiation doses of <6000–6600 cGy appear to have a low risk of development of radiation plexopathy and there is an increased risk with each 1000 cGy of radiation greater than 6000 cGy ( Yan et al, 2019 ).…”

Section: The Brachial Plexusmentioning

confidence: 99%

“…A meta-analysis of studies assessing the risk of radiation brachial plexopathy relative to the radiation dose found that the radiation dose was ≤6000 cGy in 62.5% of studies that reported <5% incidence of radiation plexopathy, and ≤6600 cGy in 75% of the studies with the same incidence ( Yan et al, 2019 ). Thus, maximum radiation doses of <6000–6600 cGy appear to have a low risk of development of radiation plexopathy and there is an increased risk with each 1000 cGy of radiation greater than 6000 cGy ( Yan et al, 2019 ). Other factors that may increase the likelihood of developing radiation plexopathy include increased number of ports of radiation administration, the administration of adjunctive chemotherapy, and the extent of axillary node dissection ( Emami et al, 1991 ).…”

Section: The Brachial Plexusmentioning

confidence: 99%

See 1 more Smart Citation

Brachial and lumbosacral plexopathies: A review

Rubin

2020

Clinical Neurophysiology Practice

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The radiation dose tolerance of the brachial plexus: A systematic review and meta-analysis

Cited by 34 publications

References 48 publications

Estimating the Tolerance of Brachial Plexus to Hypofractionated Stereotactic Body Radiotherapy – A Modelling-based Approach from Clinical Experience.

Estimating the Tolerance of Brachial Plexus to Hypofractionated Stereotactic Body Radiotherapy – A Modelling-based Approach from Clinical Experience.

Radiation-Induced Brachial Plexopathy in Breast Cancer and the Role of Surgical Treatment

Brachial and lumbosacral plexopathies: A review

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