Radiation-Induced Plexopathy and Fibrosis

Hoeller, Ulrike; Bonacker, Michael; Bajrovic, Amira; Alberti, Winfried; Adam, Gustav

doi:10.1007/s00066-004-1240-3

Cited by 40 publications

(10 citation statements)

References 21 publications

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“…2019; 6(4):e86686. 3 has a pivotal role, like fibroblasts and various infiltrating inflammatory cells, as well as extracellular matrix components, are found in the surrounding connective tissue (30). The physiologyof radiation-induced damage is yet not clear.…”

Section: Outcomementioning

confidence: 99%

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

Vinciguerra

Nardone²,

Sicurelli

et al. 2019

Arch Neurosci

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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.

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Section: Outcomementioning

confidence: 99%

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

Vinciguerra

Nardone²,

Sicurelli

et al. 2019

Arch Neurosci

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“…In some cases, the differential diagnosis between RIF and malignancy can be confirmed by magnetic resonance imaging (MRI) 45,46. Differential diagnosis should include nephrogenic systemic fibrosis (NSF, also known as nephrogenic fibrosis dermopathy).…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

117

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Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

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“…Wouter et.al reported swelling of the plexus and hyper-intensity within the trunks on T2-weighted MR imaging in breast cancer [ 27 ], which is consistent with those in our study. Radiation-induced fibrosis of supraclavicular and axillary soft tissues was also described in a significant number (about 66.7%) of patients as a reduction in signal intensity of the adipose tissue in T1 and T2 weighted sequences [ 24 , 26 , 28 , 29 ]. In contrast, the adjacent soft tissue surrounding the plexus in our patients was usually well preserved.…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study

Cai

et al. 2016

Oncotarget

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Radiation-induced brachial plexopathy (RIBP) is one of the late complications in nasopharyngeal carcinoma (NPC) patients who received radiotherapy. We conducted a retrospective study to investigate its clinical characteristics and risk factors. Thirty-onepatients with RIBP after radiotherapy for NPC were enrolled. Clinical manifestations of RIBP, electrophysiologic data, magnetic resonance imaging (MRI), and the correlation between irradiation strategy and incidence of RIBP were evaluated. The mean latency at the onset of RIBP was 4.26 years. Of the symptoms, paraesthesia usually presented first (51.6%), followed by pain (22.6%) and weakness (22.6%). The major symptoms included paraesthesia (90.3%), pain (54.8%), weakness (48.4%), fasciculation (19.3%) and muscle atrophy (9.7%). Nerve conduction velocity (NCV) and electromyography (EMG) disclosed that pathological changes of brachial plexus involved predominantly in the upper and middle trunks in distribution. MRI of the brachial plexus showed hyper-intensity on T1, T2, post-contrast T1 and diffusion weighted whole body imaging with background body signal suppression (DWIBS) images in lower cervical nerves. Radiotherapy with Gross Tumor volume (GTVnd) and therapeutic dose (mean 66.8±2.8Gy) for patients with lower cervical lymph node metastasis was related to a significantly higher incidence of RIBP (P<0.001). Thus, RIBP is a severe and progressive complication of NPC after radiotherapy. The clinical symptoms are predominantly involved in upper and middle trunk of the brachial plexus in distribution. Lower cervical lymph node metastasis and corresponding radiotherapy might cause a significant increase of the RIBP incidence.

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Radiation-Induced Plexopathy and Fibrosis

Cited by 40 publications

References 21 publications

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

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

Chronic radiation-induced dermatitis: challenges and solutions

Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study

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