Dose--volume modeling of brachial plexus-associated neuropathy after radiation therapy for head-and-neck cancer: findings from a prospective screening protocol.
Int J Radiat Oncol Biol Phys
; 88(4): 771-7, 2014 Mar 15.
Article
in En
| MEDLINE
| ID: mdl-24606846
ABSTRACT
PURPOSE:
Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. METHODS AND MATERIALS Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy.RESULTS:
Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose-volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038).CONCLUSIONS:
Dose-volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Radiation Injuries
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Brachial Plexus
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Carcinoma, Squamous Cell
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Brachial Plexus Neuropathies
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Organs at Risk
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Head and Neck Neoplasms
Type of study:
Diagnostic_studies
/
Etiology_studies
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Guideline
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Observational_studies
/
Prognostic_studies
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Qualitative_research
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Risk_factors_studies
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Screening_studies
Limits:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
Language:
En
Journal:
Int J Radiat Oncol Biol Phys
Year:
2014
Document type:
Article