Radiotherapy-induced lumbosacral plexopathy in a patient with cervical cancer: a and literature review

Abstract

Radiotherapy-induced lumbosacral plexopathy in cervical cancer treatment is a very rare, but extremely serious complication. The clinical course is associated with severe bilateral lower leg pain, reduced sensation, different degrees of weakness, paresis or paralysis, and sometimes also urinary or fecal incontinence. Patient quality of life becomes significantly deteriorated. Escalating neurological disorders may make self-sufficient functioning impossible. Neurological symptoms, most often irreversible, may develop at different times after irradiation, even after more than 30 years. We present a case of neurological toxicity in a patient successfully treated for cervical cancer with pelvis and para-aortic lymph node irradiation and weekly cisplatin. Neurological symptoms developed a few weeks after completion of external irradiation, were gradually escalating and resulted in complete immobilization of the woman. We underline the significance of long-term, systematic physiotherapy and pharmacological therapy which has resulted in significant improvement of motion efficiency. The literature review concerns the questions of frequency, clinical course and mechanisms of radiation-induced plexopathy.

Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

“… 15 , 16 However, the radiosensitivity of peripheral nerves is likely enhanced by concomitant chemotherapy, and the RILSP has been reported at much lower doses (50–60 Gy), as seen in the present study, making LSP an organ at risk during IMRT planning in such patients. 17 In our study, LSP volumes (mean volume, 93.2 cm 3 ) were consistent with those described by Yi et al (mean volume, 100 cm 3 ), which also validated this study; however, it is larger than those described by Min et al (mean volume, 40.9–58.4 cm 3 ). 6 , 7 The reason for larger volumes can be explained by the contouring of LSPRs when LSP was radiologically invisible in our series.…”

Lumbosacral plexopathy: A rare long term complication of concomitant chemo-radiation for cervical cancer

“…On the other hand, some authors [ 1 , 2 , 6 , 8 ] draws attention to the use of cisplatin in the treatment of cervical cancer with known secondary peripheral neurotoxicity, our patient received five courses of cisplatin; therefore, it remains to be determined whether the concomitant use of cisplatin with radiation will result in an increase in this neurological complication in our case.…”

“…For a number of years, radio-chemotherapy has been a treatment of choice in cervical cancer patients, starting from stage IB2 [ 2 ]. Radiation induced Lumbosacral plexophaty (RILP) is a rare but severe complication; its frequency ranges from 0.3 % to 1.3 % [ 2 , 3 ]; it is characterized by a latent period between radiation exposure and the development of symptoms, according to data from the literature, it may take even 30 years from the end of radiotherapy to occurrence of neurological symptoms [ 2 , 4 – 6 ].…”

“…Recently, it has been suggested that the use of combined treatment might also lower the spinal cord tolerance to radiotherapy [ 1 , 2 , 6 , 8 ]. In this present case, the proposed ballistic included only an anteroposterior/posteroanterior fields to 46 Gy, leaving the plexus inside all the time, with an additional 15 Gy of brachytherapy.…”

“…One of the complications associated with pelvic radiation that is extremely rare but, at the same time, provides many diagnostic and even more therapeutic problems is radiation- induced lumbosacral plexopathy (RILP) [ 1 , 2 ]. It is a chronic handicap, frightening because progressive and usually irreversible, usually appearing several years after radiotherapy [ 1 ]; diagnosis is by exclusion and the treatment remains a matter of development thanks to the better understanding of its pathophysiology.…”