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Title: Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors

Abstract

Purpose: To describe the damage to the muscles and propose a pathophysiologic mechanism for muscle atrophy and weakness after mantle field radiotherapy in Hodgkin lymphoma (HL) survivors. Methods and Materials: We examined 12 patients treated by mantle field radiotherapy between 1969 and 1998. Besides evaluation of their symptoms, the following tests were performed: dynamometry; ultrasound of the sternocleidomastoid, biceps, and antebrachial flexor muscles; and needle electromyography of the neck, deltoid, and ultrasonographically affected arm muscles. Results: Ten patients (83%) experienced neck complaints, mostly pain and muscle weakness. On clinical examination, neck flexors were more often affected than neck extensors. On ultrasound, the sternocleidomastoid was severely atrophic in 8 patients, but abnormal echo intensity was seen in only 3 patients. Electromyography of the neck muscles showed mostly myogenic changes, whereas the deltoid, biceps, and antebrachial flexor muscles seemed to have mostly neurogenic damage. Conclusions: Many patients previously treated by mantle field radiotherapy develop severe atrophy and weakness of the neck muscles. Neck muscles within the radiation field show mostly myogenic damage, and muscles outside the mantle field show mostly neurogenic damage. The discrepancy between echo intensity and atrophy suggests that muscle damage is most likely caused by an extrinsic factor suchmore » as progressive microvascular fibrosis. This is also presumed to cause damage to nerves within the radiated field, resulting in neurogenic damage of the deltoid and arm muscles.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [3]
  1. Department of Internal Medicine, St. Antonius Hospital, Nieuwegein (Netherlands)
  2. Department of Neurology, Medisch Spectrum Twente, Enschede (Netherlands)
  3. Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands)
  4. Department of Internal Medicine, University Medical Center Utrecht (Netherlands)
  5. Department of Neurology and Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein (Netherlands)
Publication Date:
OSTI Identifier:
22056002
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 82; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ATROPHY; DAMAGE; EVALUATION; FIBROSIS; HEAD; LYMPHOMAS; MUSCLES; NECK; NERVES; PAIN; PATIENTS; RADIOTHERAPY

Citation Formats

Leeuwen-Segarceanu, Elena M. van, E-mail: e.segarceanu@antoniusziekenhuis.nl, Dorresteijn, Lucille D.A., Pillen, Sigrid, Biesma, Douwe H., Vogels, Oscar J.M., and Alfen, Nens van. Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2010.11.064.
Leeuwen-Segarceanu, Elena M. van, E-mail: e.segarceanu@antoniusziekenhuis.nl, Dorresteijn, Lucille D.A., Pillen, Sigrid, Biesma, Douwe H., Vogels, Oscar J.M., & Alfen, Nens van. Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors. United States. doi:10.1016/J.IJROBP.2010.11.064.
Leeuwen-Segarceanu, Elena M. van, E-mail: e.segarceanu@antoniusziekenhuis.nl, Dorresteijn, Lucille D.A., Pillen, Sigrid, Biesma, Douwe H., Vogels, Oscar J.M., and Alfen, Nens van. Wed . "Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors". United States. doi:10.1016/J.IJROBP.2010.11.064.
@article{osti_22056002,
title = {Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors},
author = {Leeuwen-Segarceanu, Elena M. van, E-mail: e.segarceanu@antoniusziekenhuis.nl and Dorresteijn, Lucille D.A. and Pillen, Sigrid and Biesma, Douwe H. and Vogels, Oscar J.M. and Alfen, Nens van},
abstractNote = {Purpose: To describe the damage to the muscles and propose a pathophysiologic mechanism for muscle atrophy and weakness after mantle field radiotherapy in Hodgkin lymphoma (HL) survivors. Methods and Materials: We examined 12 patients treated by mantle field radiotherapy between 1969 and 1998. Besides evaluation of their symptoms, the following tests were performed: dynamometry; ultrasound of the sternocleidomastoid, biceps, and antebrachial flexor muscles; and needle electromyography of the neck, deltoid, and ultrasonographically affected arm muscles. Results: Ten patients (83%) experienced neck complaints, mostly pain and muscle weakness. On clinical examination, neck flexors were more often affected than neck extensors. On ultrasound, the sternocleidomastoid was severely atrophic in 8 patients, but abnormal echo intensity was seen in only 3 patients. Electromyography of the neck muscles showed mostly myogenic changes, whereas the deltoid, biceps, and antebrachial flexor muscles seemed to have mostly neurogenic damage. Conclusions: Many patients previously treated by mantle field radiotherapy develop severe atrophy and weakness of the neck muscles. Neck muscles within the radiation field show mostly myogenic damage, and muscles outside the mantle field show mostly neurogenic damage. The discrepancy between echo intensity and atrophy suggests that muscle damage is most likely caused by an extrinsic factor such as progressive microvascular fibrosis. This is also presumed to cause damage to nerves within the radiated field, resulting in neurogenic damage of the deltoid and arm muscles.},
doi = {10.1016/J.IJROBP.2010.11.064},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 82,
place = {United States},
year = {2012},
month = {2}
}