Group on guidelines for the management of women with adverse effects following radiotherapy for breast cancer

Abstract

Patients treated for breast cancer may suffer a range of upper limb problems, from mild oedema and inner arm sensation changes related to surgery, to the rare, but severely disabling, brachial plexus neuropathy associated with radiation damage. This has been brought to public attention by a group of patients, Radiation Action Group Exposure (RAGE), who claim to have suffered such damage. As a result of a House of Lords' debate (May 1994), the Department of Health established a multidisciplinary committee to assess the optimum management of axillary tunnel damage following radiotherapy for breast cancer and the availability of specialist services for such management, and to make recommendations on how services for this might best be organized. The committee was convened in November 1994. Assessment of optimal management and current availability of specialist services was based on consultation with RAGE, a literature review (references available on request), and consultation with a wide variety of individual experts and organizations. Reports vary widely of the incidence of radiationinduced brachial plexopathy (RIBP) among women who have undergone postoperative axillary irradiation. This probably reflects differing criteria for diagnosis and the range of dose and fractionation schedules described in the literature. However, it is a rare complication, probably affecting less than 1% of treated patients. Its rarity means that a general practitioner is unlikely to see a single such patient during his or her professional lifetime. Similarly, many health care professionals involved in the treatment of breast cancer may be unfamiliar with the clinical features of RIBP. Typically, a patient will present with numbness of the fingers. Wasting of the small muscles of the hand will follow within months or years. Pain will take a variable course: characteristically it follows the distribution of nerves Supplied by C5 and C6, although it may involve the whole brachial plexus. Between oneand two-thirds of patients with RIBP will develop progressive loss of function of the hand and arm over a period of months or years.