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...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 1993-04, Vol.26 (1), p.43-49 |
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| container_title | International journal of radiation oncology, biology, physics |
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| creator | Olsen, Niels Kjær Pfeiffer, Per Johannsen, Lis Schrøder, Henrik Rose, Carsten |
| description | 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 |
| doi_str_mv | 10.1016/0360-3016(93)90171-Q |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_6701099</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>036030169390171Q</els_id><sourcerecordid>036030169390171Q</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-ced2daebfa7c3cad4fc3aa38e804d61d54c93e6793da7c3d9997b1c755a5f0573</originalsourceid><addsrcrecordid>eNp9kE1r3DAQhkVoSDfb_IMWTOkhOSiVItuyeiiUkC8IKSkt9Ca0o3FWqdcykpw0_75yvOyxJw16nxleHkLec3bKGa8_M1EzKvJ0rMSJYlxyer9HFryRioqq-v2GLHbIW3IY4yNjjHNZHpCDRjSS1XJB_vww1pnkfE9db0dAW6yCgbUzXTF0-NcPJq1fvhR3OAbf-QcHOWh91_lnOg6F6wte8yIgjCFgD0jbgJhPoImpAJN_QpFPOOxTfEf2W9NFPNq-S_Lr8uLn-TW9_X51c_7tlkJZl4nmDmfW4Ko1EgQYW7YgjBENNqy0NbdVCUpgLZWwE2GVUnLFQVaVqVpWSbEkH-e7PianI7iEsAbf9whJ15JxplSGyhmC4GMM2OohuI0JL5ozPfnVkzw9ydNK6Fe_-j6vfZjXhnG1Qbtb2grN-adtbmJW1YaswMUdVkpR8bMJ-zpjmD08OQxTzcmfdWFqab37f49_k8KYiw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Olsen, Niels Kjær ; Pfeiffer, Per ; Johannsen, Lis ; Schrøder, Henrik ; Rose, Carsten</creator><creatorcontrib>Olsen, Niels Kjær ; Pfeiffer, Per ; Johannsen, Lis ; Schrøder, Henrik ; Rose, Carsten</creatorcontrib><description>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</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/0360-3016(93)90171-Q</identifier><identifier>PMID: 8387067</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biological and medical sciences ; BIOLOGICAL EFFECTS ; BIOLOGICAL RADIATION EFFECTS ; BODY ; Brachial plexopathy ; Brachial Plexus ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Combined Modality Therapy ; Cytotoxic therapy ; Denmark - epidemiology ; Female ; Follow-Up Studies ; FRACTIONATED IRRADIATION ; Genital system. Mammary gland ; GLANDS ; Humans ; Incidence ; IRRADIATION ; MAMMARY GLANDS ; Mastectomy, Simple ; Medical sciences ; MEDICINE ; Middle Aged ; NERVOUS SYSTEM ; NUCLEAR MEDICINE ; ORGANS ; Peripheral Nervous System Diseases - epidemiology ; Peripheral Nervous System Diseases - etiology ; RADIATION EFFECTS ; RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT ; RADIOLOGY ; RADIOTHERAPY ; Radiotherapy - adverse effects ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; SIDE EFFECTS ; THERAPY 560151 -- Radiation Effects on Animals-- Man</subject><ispartof>International journal of radiation oncology, biology, physics, 1993-04, Vol.26 (1), p.43-49</ispartof><rights>1993</rights><rights>1993 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-ced2daebfa7c3cad4fc3aa38e804d61d54c93e6793da7c3d9997b1c755a5f0573</citedby><cites>FETCH-LOGICAL-c464t-ced2daebfa7c3cad4fc3aa38e804d61d54c93e6793da7c3d9997b1c755a5f0573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0360-3016(93)90171-Q$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4735127$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8387067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/6701099$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Olsen, Niels Kjær</creatorcontrib><creatorcontrib>Pfeiffer, Per</creatorcontrib><creatorcontrib>Johannsen, Lis</creatorcontrib><creatorcontrib>Schrøder, Henrik</creatorcontrib><creatorcontrib>Rose, Carsten</creatorcontrib><title>Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>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</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>BIOLOGICAL EFFECTS</subject><subject>BIOLOGICAL RADIATION EFFECTS</subject><subject>BODY</subject><subject>Brachial plexopathy</subject><subject>Brachial Plexus</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Combined Modality Therapy</subject><subject>Cytotoxic therapy</subject><subject>Denmark - epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>FRACTIONATED IRRADIATION</subject><subject>Genital system. Mammary gland</subject><subject>GLANDS</subject><subject>Humans</subject><subject>Incidence</subject><subject>IRRADIATION</subject><subject>MAMMARY GLANDS</subject><subject>Mastectomy, Simple</subject><subject>Medical sciences</subject><subject>MEDICINE</subject><subject>Middle Aged</subject><subject>NERVOUS SYSTEM</subject><subject>NUCLEAR MEDICINE</subject><subject>ORGANS</subject><subject>Peripheral Nervous System Diseases - epidemiology</subject><subject>Peripheral Nervous System Diseases - etiology</subject><subject>RADIATION EFFECTS</subject><subject>RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT</subject><subject>RADIOLOGY</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy - adverse effects</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>SIDE EFFECTS</subject><subject>THERAPY 560151 -- Radiation Effects on Animals-- Man</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1r3DAQhkVoSDfb_IMWTOkhOSiVItuyeiiUkC8IKSkt9Ca0o3FWqdcykpw0_75yvOyxJw16nxleHkLec3bKGa8_M1EzKvJ0rMSJYlxyer9HFryRioqq-v2GLHbIW3IY4yNjjHNZHpCDRjSS1XJB_vww1pnkfE9db0dAW6yCgbUzXTF0-NcPJq1fvhR3OAbf-QcHOWh91_lnOg6F6wte8yIgjCFgD0jbgJhPoImpAJN_QpFPOOxTfEf2W9NFPNq-S_Lr8uLn-TW9_X51c_7tlkJZl4nmDmfW4Ko1EgQYW7YgjBENNqy0NbdVCUpgLZWwE2GVUnLFQVaVqVpWSbEkH-e7PianI7iEsAbf9whJ15JxplSGyhmC4GMM2OohuI0JL5ozPfnVkzw9ydNK6Fe_-j6vfZjXhnG1Qbtb2grN-adtbmJW1YaswMUdVkpR8bMJ-zpjmD08OQxTzcmfdWFqab37f49_k8KYiw</recordid><startdate>19930430</startdate><enddate>19930430</enddate><creator>Olsen, Niels Kjær</creator><creator>Pfeiffer, Per</creator><creator>Johannsen, Lis</creator><creator>Schrøder, Henrik</creator><creator>Rose, Carsten</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>OTOTI</scope></search><sort><creationdate>19930430</creationdate><title>Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients</title><author>Olsen, Niels Kjær ; Pfeiffer, Per ; Johannsen, Lis ; Schrøder, Henrik ; Rose, Carsten</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-ced2daebfa7c3cad4fc3aa38e804d61d54c93e6793da7c3d9997b1c755a5f0573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>BIOLOGICAL EFFECTS</topic><topic>BIOLOGICAL RADIATION EFFECTS</topic><topic>BODY</topic><topic>Brachial plexopathy</topic><topic>Brachial Plexus</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Combined Modality Therapy</topic><topic>Cytotoxic therapy</topic><topic>Denmark - epidemiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>FRACTIONATED IRRADIATION</topic><topic>Genital system. Mammary gland</topic><topic>GLANDS</topic><topic>Humans</topic><topic>Incidence</topic><topic>IRRADIATION</topic><topic>MAMMARY GLANDS</topic><topic>Mastectomy, Simple</topic><topic>Medical sciences</topic><topic>MEDICINE</topic><topic>Middle Aged</topic><topic>NERVOUS SYSTEM</topic><topic>NUCLEAR MEDICINE</topic><topic>ORGANS</topic><topic>Peripheral Nervous System Diseases - epidemiology</topic><topic>Peripheral Nervous System Diseases - etiology</topic><topic>RADIATION EFFECTS</topic><topic>RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT</topic><topic>RADIOLOGY</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy - adverse effects</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>SIDE EFFECTS</topic><topic>THERAPY 560151 -- Radiation Effects on Animals-- Man</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Olsen, Niels Kjær</creatorcontrib><creatorcontrib>Pfeiffer, Per</creatorcontrib><creatorcontrib>Johannsen, Lis</creatorcontrib><creatorcontrib>Schrøder, Henrik</creatorcontrib><creatorcontrib>Rose, Carsten</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Olsen, Niels Kjær</au><au>Pfeiffer, Per</au><au>Johannsen, Lis</au><au>Schrøder, Henrik</au><au>Rose, Carsten</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>1993-04-30</date><risdate>1993</risdate><volume>26</volume><issue>1</issue><spage>43</spage><epage>49</epage><pages>43-49</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>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</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8387067</pmid><doi>10.1016/0360-3016(93)90171-Q</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0360-3016 |
| ispartof | International journal of radiation oncology, biology, physics, 1993-04, Vol.26 (1), p.43-49 |
| issn | 0360-3016 1879-355X |
| language | eng |
| recordid | cdi_osti_scitechconnect_6701099 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences BIOLOGICAL EFFECTS BIOLOGICAL RADIATION EFFECTS BODY Brachial plexopathy Brachial Plexus Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Combined Modality Therapy Cytotoxic therapy Denmark - epidemiology Female Follow-Up Studies FRACTIONATED IRRADIATION Genital system. Mammary gland GLANDS Humans Incidence IRRADIATION MAMMARY GLANDS Mastectomy, Simple Medical sciences MEDICINE Middle Aged NERVOUS SYSTEM NUCLEAR MEDICINE ORGANS Peripheral Nervous System Diseases - epidemiology Peripheral Nervous System Diseases - etiology RADIATION EFFECTS RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT RADIOLOGY RADIOTHERAPY Radiotherapy - adverse effects Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) SIDE EFFECTS THERAPY 560151 -- Radiation Effects on Animals-- Man |
| title | Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients |
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