Brachial plexus-associated neuropathy after high-dose radiation therapy for head-and-neck cancer

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

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

Original languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume84
Issue number1
DOIs
StatePublished - Sep 1 2012

Fingerprint

Brachial Plexus Neuropathies
Head and Neck Neoplasms
radiation therapy
Radiotherapy
cancer
dosage
Brachial Plexus
Radiation
dissection
Neck Dissection
radiation
chemotherapy
Arm Injuries
atrophy
Drug Therapy
Muscular Atrophy
Hypesthesia
pain
muscles
regression analysis

Keywords

  • Brachial plexopathy
  • Head and neck
  • Quality of life
  • Radiation
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

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.

In: International Journal of Radiation Oncology Biology Physics, Vol. 84, No. 1, 01.09.2012, p. 165-169.

Research output: Contribution to journalArticle

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abstract = "Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47{\%}) were treated by definitive radiation therapy, and 175 (53{\%}) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62{\%} of cases, and 133 patients (40{\%}) received concurrent chemotherapy. Results: Forty patients (12{\%}) reported neuropathic symptoms, with the most common being ipsilateral pain (50{\%}), numbness/tingling (40{\%}), motor weakness, and/or muscle atrophy (25{\%}). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22{\%}. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.",
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