Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study.

Zhaoxi Cai,Jinjun Luo,Ruying Fu,Xiaoming Rong,Yamei Tang,Yi Li,Jinping Cheng,Zhen Hu,Rong Wu,Xiaolong Huang

doi:10.18632/oncotarget.7748

Abstract

Radiation-induced brachial plexopathy (RIBP) is one of the late complications in nasopharyngeal carcinoma (NPC) patients who received radiotherapy. We conducted a retrospective study to investigate its clinical characteristics and risk factors. Thirty-onepatients with RIBP after radiotherapy for NPC were enrolled. Clinical manifestations of RIBP, electrophysiologic data, magnetic resonance imaging (MRI), and the correlation between irradiation strategy and incidence of RIBP were evaluated. The mean latency at the onset of RIBP was 4.26 years. Of the symptoms, paraesthesia usually presented first (51.6%), followed by pain (22.6%) and weakness (22.6%). The major symptoms included paraesthesia (90.3%), pain (54.8%), weakness (48.4%), fasciculation (19.3%) and muscle atrophy (9.7%). Nerve conduction velocity (NCV) and electromyography (EMG) disclosed that pathological changes of brachial plexus involved predominantly in the upper and middle trunks in distribution. MRI of the brachial plexus showed hyper-intensity on T1, T2, post-contrast T1 and diffusion weighted whole body imaging with background body signal suppression (DWIBS) images in lower cervical nerves. Radiotherapy with Gross Tumor volume (GTVnd) and therapeutic dose (mean 66.8±2.8Gy) for patients with lower cervical lymph node metastasis was related to a significantly higher incidence of RIBP (P<0.001). Thus, RIBP is a severe and progressive complication of NPC after radiotherapy. The clinical symptoms are predominantly involved in upper and middle trunk of the brachial plexus in distribution. Lower cervical lymph node metastasis and corresponding radiotherapy might cause a significant increase of the RIBP incidence.

Highlights

Nasopharyngeal carcinoma (NPC) is a common malignant tumor and highly prevalent in East Asia [1,2,3], especially in Southern China
Lower cervical lymph node metastasis and corresponding radiotherapy might cause a significant increase of the Radiation-induced brachial plexopathy (RIBP) incidence
Www.impactjournals.com/oncotarget radiation-induced plexopathy has been documented in patients with neoplasms of the mediastinum, breast, lung and lymph nodes, there is paucity in literature on radiation-induced brachial plexopathy (RIBP) in patient with nasopharyngeal carcinoma (NPC) after radiotherapy [11,12,13,14,15,16,17,18]

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a common malignant tumor and highly prevalent in East Asia [1,2,3], especially in Southern China. Radiotherapy remains the primary treatment of the choice for NPC, which may adversely cause complications [4]. Implementation of three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) permits a precise dose emitting, and significantly reduces complications of the radiotherapy [5,6,7]. Www.impactjournals.com/oncotarget radiation-induced plexopathy has been documented in patients with neoplasms of the mediastinum, breast, lung and lymph nodes, there is paucity in literature on radiation-induced brachial plexopathy (RIBP) in patient with NPC after radiotherapy [11,12,13,14,15,16,17,18]. Relationships between the cervical lymph node infiltration, corresponding radiation planning and incidence of RIBP have never been discussed.

Methods

Results

Conclusion