Brachial plexus syndrome (BPS) due to primary or locally recurrent breast cancer (BC)

Abstract

748 Backround: BC-associated BPS has been ascribed to radiation (RT) plexopathy but may also be associated with primary or locally recurrent BC. BPS often causes severe pain and/or disability. Methods: We retrospectively surveyed all our BC pts, including 580 with locally advanced BC (LABC), for those meeting criteria for BPS: 1) Intractable homolateral arm pain, without cervical spine or humerus metastases; and/or, 2) Arm &/or hand weakness and hyporeflexia. Pts meeting these criteria were evaluated for associated untreated primary tumors or local recurrences, and for the responses of their BPS to RT or chemotherapy (CT). Results: 29 pts met these criteria for BPS. Narcotic analgesia was required by 16/29. Motor deficits, were present in 23/29, and were incapacitating in 10/29. Arm edema developed synchronously with BPS symptoms in 17/29, and was severe in 8/29. BPS presented in association with untreated, LABC in 7/29 pts; 4/7 had matted or fixed axillary nodes, 2 supraclavicular nodes (SCN), and 3 chest wall (CW) invasion. BPS presented 7–180 months (median 31) after prior treatment of 22/29 pts’ primary BC. Prior treatment included mastectomy in 16/22, tumorectomy in 6/22, RT in 13/22 and (CT) in 20/22. Nine of these 22 pts had 4–18 nodes involved by tumor, but 5/9 had refused RT. When their BPS presented, 19/22 pts had recurred locally: 13/19 on the upper CW, 13/22 in SCN, and 4 at both sites. Two of 3 pts without local recurrence had received RT. 22 pts with BPS and associated local tumor masses were treated; partial or complete responses occurred to RT in 6/8, and to CT in 9/17. The overall response rate was 14/17 (82%). Remission duration ranged from 2–60 months, (median 10 months.) Untreated or unresponsive pts had incapacitating arm weakness and intractable pain. Conclusions: BPS is most frequently associated with local recurrences of BC, in SCN or the upper chest wall. Prompt RT or CT can durably alleviate BPS. No significant financial relationships to disclose.