Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel A.; Farwell, D. Gregory; Lau, Derick H; Purdy, James A.

doi:10.1016/j.ijrobp.2011.11.019

Cited by 71 publications

(50 citation statements)

References 20 publications

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“…108,109 The brachial plexus consists of nerve fibres relaying sensory, autonomic and motor innervation to and from the arm, forearm and hand. Correspondingly, the majority of symptoms of BPN are experienced in the ipsilateral upper extremity and include paraesthesia, motor weakness, pain and oedema.…”

Section: Neural Injurymentioning

confidence: 99%

Pain in cancer survivors

Brown

Ramirez

Farquhar-Smith

2014

British Journal of Pain

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Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients' quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available.

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Section: Neural Injurymentioning

confidence: 99%

Pain in cancer survivors

Brown

Ramirez

Farquhar-Smith

2014

British Journal of Pain

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“…2 recently reported the first study suggesting a dose-response relationship for the development of brachial plexopathies with a 1.39 times greater odds of developing symptoms with each 1 Gy increase in the maximum BP dose. On multivariate analysis, neck dissection (hazard ratio = 9.55; p < 0.001) and maximum BP dose (hazard ratio = 1.87; p < 0.001) were independent predictors of brachial plexopathy.…”

Section: Discussionmentioning

confidence: 99%

“…1 A recent report has suggested that brachial plexopathy symptoms maybe underreported in the HNC population, with a risk approaching 12% correlating with a dose-response relationship for the development of brachial plexus (BP)–related neuropathies among patients treated with radiotherapy for HNC. 2 Within the past 10 years, intensity-modulated radiotherapy (IMRT) has emerged as the standard radiotherapy approach for treating HNC. The radiation dose to the BP is significantly increased among patients undergoing IMRT compared with conventional radiotherapy for the treatment of HNC.…”

Section: Introductionmentioning

confidence: 99%

“…4 The maximum dose to the BP in patients receiving IMRT has been shown to be a significant contributing factor in the development of symptomatic brachial plexopathy. 2 Exploring dosimetric factors that may contribute to a greater risk of brachial plexopathy will help define and determine attainable dose limits to the BP during IMRT optimization, which may subsequently reduce the risk of BP-related complications. Hence, the purpose of this study was to evaluate the influence of volumetric tumor burden on planned BP dose in head and neck IMRT, when the BP is routinely contoured as an avoidance structure for IMRT optimization.…”

Section: Introductionmentioning

confidence: 99%

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Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

Romesser¹,

Qureshi

Kovalchuk

et al. 2014

Medical Dosimetry

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To determine the effect of gross tumor volume of the primary (GTV-P) and nodal (GTV-N) disease on planned radiation dose to the brachial plexus (BP) in head and neck intensity-modulated radiotherapy (IMRT). Overall, 75 patients underwent definitive IMRT to a median total dose of 69.96 Gy in 33 fractions. The right BP and left BP were prospectively contoured as separate organs at risk. The GTV was related to BP dose using the unpaired t-test. Receiver operating characteristics curves were constructed to determine optimized volumetric thresholds of GTV-P and GTV-N corresponding to a maximum BP dose cutoff of > 66 Gy. Multivariate analyses were performed to account for factors associated with a higher maximal BP dose. A higher maximum BP dose (> 66 vs ≤ 66 Gy) correlated with a greater mean GTV-P (79.5 vs 30.8 cc; p = 0.001) and ipsilateral GTV-N (60.6 vs 19.8 cc; p = 0.014). When dichotomized by the optimized nodal volume, patients with an ipsilateral GTV-N ≥ 4.9 vs < 4.9 cc had a significant difference in maximum BP dose (64.2 vs 59.4 Gy; p = 0.001). Multivariate analysis confirmed that an ipsilateral GTV-N ≥ 4.9 cc was an independent predictor for the BP to receive a maximal dose of > 66 Gy when adjusted individually for BP volume, GTV-P, the use of a low anterior neck field technique, total planned radiation dose, and tumor category. Although both the primary and the nodal tumor volumes affected the BP maximal dose, the ipsilateral nodal tumor volume (GTV-N ≥ 4.9 cc) was an independent predictor for high maximal BP dose constraints in head and neck IMRT.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Mutter

Lok

Dutta

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Background: Accumulating evidence suggests that brachial plexopathy following head and neck cancer radiotherapy may be underreported and that this toxicity is associated with a dose-response. Our purpose was to determine whether the dose to the brachial plexus (BP) can be constrained, without compromising regional control. Methods: The radiation plans of 324 patients with oropharyngeal carcinoma (OPC) treated with intensity-modulated radiation therapy (IMRT) were reviewed. We identified 42 patients (13%) with gross nodal disease <1 cm from the BP. Normal tissue constraints included a maximum dose of 66 Gy and a D 05 of 60 Gy for the BP. These criteria took precedence over planning target volume (PTV) coverage of nodal disease near the BP.

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Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

Cited by 71 publications

References 20 publications

Pain in cancer survivors

Pain in cancer survivors

Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

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

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