Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

Journal Article · Sat Sep 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.11.019· OSTI ID:22149463

Hall, William H. ^[1]; Li, Judy; Beckett, Laurel ^[2]; Farwell, D. Gregory ^[3]; Lau, Derick H. ^[4]; Purdy, James A. ^[1]

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1. Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States)
2. Department of Biostatistics, University of California, Davis School of Medicine, Sacramento, California (United States)
3. Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California (United States)
4. Department of Medical Oncology, University of California, Davis School of Medicine, Sacramento, California (United States)

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.

• OSTI ID: 22149463
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 84; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ATROPHY
CHEMOTHERAPY
DOSE-RESPONSE RELATIONSHIPS
HEAD
MUSCLES
NECK
NEOPLASMS
NERVES
PAIN
PATIENTS
RADIATION DOSES
RADIATION INJURIES
RADIOTHERAPY
REGRESSION ANALYSIS
SCREENING
STANDARD OF LIVING
TOXICITY