Early transient radiation-induced brachial plexopathy in locally advanced head and neck cancer

Metcalfe, Evrim; Etiz, Durmuş

doi:10.5114/wo.2015.55876

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…In addition, four studies were excluded due to lack of quantitative data (Platteaux et al., 2010; Sood et al., 2018; Thomas et al., 2015; Truong et al., 2012). Finally, 30 studies were included in the systematic review (Figure 1) (Amini et al., 2012; Basso-Ricci et al., 1980; Brunelli and Brunelli, 1985; Cai et al., 2016; Chen et al., 2012; Eblan et al., 2013; Fardin et al., 1990; Fathers et al., 2002; Forquer et al., 2009; Gosk et al., 2007; Hoeller et al., 2004; Johansson et al., 2000; Kıbıcı et al., 2020; Killer and Hess, 1990; Ko et al., 2011; Kori et al., 1981; LeQuang, 1989; Lindberg et al., 2019; Merle et al., 1988; Metcalfe and Etiz, 2016; Mondrup et al., 1990; Morse et al., 2022; Narakas, 1984; Pierce et al., 1992; Powell et al., 1990; Studer et al., 2014; Teixeira et al., 2007; Warade et al., 2019; Wu et al., 2014; Yin et al., 2023). Figure 2 shows the distribution of the included studies based on the publication year.…”

Section: Resultsmentioning

confidence: 99%

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Shekouhi,

Gerhold,

Chim

2023

J Hand Surg Eur Vol

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This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss ( n = 323, 62%), followed by motor deficits ( n = 294, 56%) and neuropathic pain ( n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage ( n = 108, 6%), followed by neurolysis alone ( n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.

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Section: Resultsmentioning

confidence: 99%

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Shekouhi,

Gerhold,

Chim

2023

J Hand Surg Eur Vol

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“…3 However, 1 radiation-treated series of head and neck cancers using a prospective questionnaire suggested transient radiation-induced brachial plexopathy in 7.0% of patients, but those patients had complete resolution. 14 In addition, 1 large series of radiation-treated breast cancer found 1.4% of patients had transient brachial plexopathy. 15…”

Section: Discussionmentioning

confidence: 99%

“…3 However, 1 radiationtreated series of head and neck cancers using a prospective questionnaire suggested transient radiation-induced brachial plexopathy in 7.0% of patients, but those patients had complete resolution. 14 In addition, 1 large series of radiation-treated breast cancer found 1.4% of patients had transient brachial plexopathy. 15 Two distinct clinical courses were observed in our series: one with monophasic course improving over time and another with chronic progressive course slowly worsening over time.…”

Section: Chronic Progressivementioning

confidence: 99%

Clinical, Neurophysiologic, and Pathologic Features in Patients With Early-Onset Postradiation Neuropathy

et al. 2023

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Objective:To study early-onset radiation-induced neuropathy reviewing neurologic course, steroid-response, and available nerve biopsies.Methods:Patients coded with radiation-induced neuropathy within six-months of radiation were reviewed from January 1st,1999-August 31st, 2022. Patients had to have electrodiagnostically confirmed neuropathy localized within or distal to radiation fields. Neurological course and nerve biopsies were reviewed.Results:Twenty-eight patients (16 males and 12 females, mean age 63.8 years) were identified. Average radiation dose was 4659cGy (range 1000-7208). Tumor infiltration was not observed on MRI and PET. Post radiation onsets averaged 2 months (range 0-5). Localizations included brachial (n=4) plexopathies, lumbosacral (n=12) plexopathies, radiculopathies (n=10), and mononeuropathies (n=2). Neuropathic pain (n=25) and weakness (n=25) were typical. The clinical courses were subacute monophasic (n=14), chronic progressive (n=8) or static (n=1), and 5 were without follow-up. Nerve biopsies (n=8) showed an inflammatory ischemic process with perivascular inflammatory infiltrates (n=7) or microvasculitis (n=2). Nine patients, 7 with monophasic courses, received steroid burst therapy with symptom improvement in 8. No patients recovered entirely back to baseline.Discussion:In contrast to chronic radiation induced neuropathy early-onset patients most commonly have painful, monophasic courses with residual deficits, possibly steroid responsive. An ischemic inflammatory pathogenesis is suggested.

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“…In fact, some reported no brachial plexopathies in 72% of patients receiving a dose superior to 60 Gy [ 124 ]. Moreover, only 2% of patients reported early transient radiation-induced brachial plexopathy after the seventh and eighth months of follow-up [ 125 ]. In addition, the therapeutic dose was neither a risk factor for brachial plexopathy in sequential IMRT [ 126 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities

Azzam¹,

Mroueh²,

Francis³

et al. 2020

ecancer

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Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.

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Early transient radiation-induced brachial plexopathy in locally advanced head and neck cancer

Cited by 7 publications

References 18 publications

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review

Clinical, Neurophysiologic, and Pathologic Features in Patients With Early-Onset Postradiation Neuropathy

Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities

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