Radiation plexopathy

Edward J Dropcho MD (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released April 26, 1996; last updated January 3, 2015; expires January 3, 2018

Overview

Brachial plexopathy is the most common complication of therapeutic irradiation affecting the peripheral nervous system. Patients treated for breast carcinoma are most often affected; radiation brachial plexopathy is a significant source of morbidity. Lumbosacral plexopathy is also an increasingly recognized complication of radiation therapy for a number of neoplasms. Newer radiation techniques, such as stereotactic body irradiation and intensity-modulated radiotherapy, also carry a risk of plexus injury. It is important for neurologists to diagnose radiation-induced plexopathies early and to differentiate them from plexus metastases or other causes of plexopathy. The author discusses the clinical presentations, diagnostic issues, and management of patients with radiation plexopathies.

Key points

• Radiation injury to the brachial plexus most often occurs after treatment for breast cancer, whereas lumbosacral plexopathy occurs after treatment of a number of primary or metastatic pelvic tumors.

• Radiation plexopathy generally presents with painless numbness and sensory symptoms in the affected limb, with variable weakness. Pain may occur, but is usually not early or prominent.

• The most frequent differential diagnosis is distinguishing radiation plexopathy from metastases to the brachial or lumbosacral plexus.

• The clinical course of radiation plexopathy is variable, though most patients suffer from progressive sensory and motor deficits. Therapy options are very limited.

Historical note and terminology

The first reports of radiation-induced brachial plexopathy appeared in the early 1960s shortly after the widespread introduction of modern megavoltage radiotherapy for treatment of breast carcinoma. Radiation brachial plexopathy is currently the most frequent complication of radiotherapy affecting the peripheral nervous system. Lumbosacral plexopathy is less common and has been clearly recognized only during the past 20 years.

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