Lumbosacral Plexopathy in Pelvic Radiotherapy: An Association not to be Neglected; A Systematic Review

Abstract

Context: Radiation-induced lumbosacral plexopathy is still under-recognized although its symptomatology can really lower the quality of life and impair self-sufficient functions of patients often cured of cancer. Objectives: This review aimed to depict radiation-induced lumbosacral plexopathy through a systematic review of the available literature and discuss various aspects of the clinical management of this pathology. Data Sources: We searched for all English medical papers registered in Web of Knowledge, PubMed, Google Scholar, and ScienceDirect from January 1990 to November 2018. Study Selection: From among all articles concerning radiotherapy and lumbosacral plexopathy, we included papers that dealt with human samples and excluded non-human samples and case reports. Results: Out of 1,312 articles, we selected 42 articles of which 21 met the eligibility criteria and were included in the present analysis. Five papers were general reviews, three focused on the diagnosis of disease, three analyzed the role of different therapies, and the remaining 10 articles concerned the methodology of radiation therapy. Conclusion: In the next future, we must analyze the dosimetry parameters and the clinical parameters, with appropriate follow-up times, thus providing sufficient data to use for developing organ sparing strategies tailored to individual patients. Therefore, we can reduce this type of side effects that have a huge impact on the quality of life of patients.

Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy

“…In case of uncertain diagnosis, imaging such as MRI evaluation and PETCT can rule out disease progression or skip metastasis. RILSN picture on MRI evaluation shows diffuse hyperintensity along the nerves in T2-weighted images and/or fascicular pattern on T1 and T2-fat suppressed sequences in the absence of tumor [38,39]. In our patients, we were unable to document such hyperintense signal changes in sacral nerves.…”