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document
Radiation-induced brachial plexopathy : neurological follow-up in 161 recurrence-free breast cancer patients . PURPOSE The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients , treated according to the Danish Breast Cancer Cooperative Group protocols . METHODS AND MATERIALS One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months ( 13-99 months ) . After total mastectomy and axillary node sampling , high-risk patients were randomized to adjuvant therapy . One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks . In addition , 82 of these patients received cytotoxic therapy ( cyclophosphamide , methotrexate , and 5-fluorouracil ) and 46 received tamoxifen . RESULTS Five percent and 9 % of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy , respectively . Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy ( p = 0.04 ) and in younger patients ( p = 0.04 ) . The clinical manifestations were paraesthesia ( 100 % ) , hypaesthesia ( 74 % ) , weakness ( 58 % ) , decreased muscle stretch reflexes ( 47 % ) , and pain ( 47 % ) . CONCLUSION The brachial plexus is more vulnerable to large fraction size . Fractions of 2 Gy or less are advisable . Cytotoxic therapy adds to the damaging effect of radiotherapy . Peripheral nerves in younger patients seems more vulnerable . Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus .
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Intervention_Physical
adjuvant therapy
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Intervention_Physical
postoperative radiotherapy
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Intervention_Pharmacological
with 50 Gy
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Intervention_Pharmacological
cytotoxic therapy
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Intervention_Pharmacological
cyclophosphamide , methotrexate , and 5-fluorouracil
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Intervention_Pharmacological
tamoxifen
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Intervention_Pharmacological
Cytotoxic therapy
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Outcome_Physical
assess the incidence and clinical manifestations
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Outcome_Physical
disabling and mild radiation-induced brachial plexopathy
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Outcome_Physical
Radiation-induced brachial plexopathy
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Outcome_Physical
paraesthesia
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Outcome_Physical
hypaesthesia
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Outcome_Physical
weakness
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Outcome_Adverse-effects
decreased muscle stretch reflexes
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Outcome_Pain
pain
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Participant_Sample-size
161
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Participant_Condition
recurrence-free breast cancer
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Participant_Age
younger