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Title: Tolerance of the Brachial Plexus to High-Dose Reirradiation

Abstract

Purpose: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Methods and Materials: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). Results: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus–related neuropathy was 67% and 86% formore » subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). Conclusion: The development of brachial plexus–related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.« less

Authors:
; ; ; ; ;
Publication Date:
OSTI Identifier:
22649910
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 1; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DOSE-RESPONSE RELATIONSHIPS; GY RANGE 100-1000; GY RANGE 10-100; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; TOLERANCE

Citation Formats

Chen, Allen M., E-mail: achen5@kumc.edu, Yoshizaki, Taeko, Velez, Maria A., Mikaeilian, Argin G., Hsu, Sophia, and Cao, Minsong. Tolerance of the Brachial Plexus to High-Dose Reirradiation. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.01.244.
Chen, Allen M., E-mail: achen5@kumc.edu, Yoshizaki, Taeko, Velez, Maria A., Mikaeilian, Argin G., Hsu, Sophia, & Cao, Minsong. Tolerance of the Brachial Plexus to High-Dose Reirradiation. United States. doi:10.1016/J.IJROBP.2017.01.244.
Chen, Allen M., E-mail: achen5@kumc.edu, Yoshizaki, Taeko, Velez, Maria A., Mikaeilian, Argin G., Hsu, Sophia, and Cao, Minsong. Mon . "Tolerance of the Brachial Plexus to High-Dose Reirradiation". United States. doi:10.1016/J.IJROBP.2017.01.244.
@article{osti_22649910,
title = {Tolerance of the Brachial Plexus to High-Dose Reirradiation},
author = {Chen, Allen M., E-mail: achen5@kumc.edu and Yoshizaki, Taeko and Velez, Maria A. and Mikaeilian, Argin G. and Hsu, Sophia and Cao, Minsong},
abstractNote = {Purpose: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Methods and Materials: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). Results: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus–related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). Conclusion: The development of brachial plexus–related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.},
doi = {10.1016/J.IJROBP.2017.01.244},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 98,
place = {United States},
year = {Mon May 01 00:00:00 EDT 2017},
month = {Mon May 01 00:00:00 EDT 2017}
}