Semin Neurol 2010; 30(3): 254-262
DOI: 10.1055/s-0030-1255219
© Thieme Medical Publishers

Neurologic Manifestations of Neoplastic and Radiation-Induced Plexopathies

Kurt A. Jaeckle1
  • 1Department of Neurology and Oncology, Mayo Clinic Florida, Jacksonville, Florida
Further Information

Publication History

Publication Date:
24 June 2010 (online)

ABSTRACT

Metastatic plexopathy is often a disabling accompaniment of advanced systemic cancer, and may involve any of the peripheral nerve plexuses. Brachial plexopathy most commonly occurs in carcinoma of the breast and lung; lumbosacral plexopathy is most common with colorectal and gynecologic tumors, sarcomas, and lymphomas. Neoplastic plexopathy is often characterized initially by severe, unrelenting pain followed by development of weakness and focal sensory disturbances. In previously treated patients, the main differential diagnostic consideration is radiation-induced plexopathy, which can be difficult to distinguish from tumor plexopathy. Diagnosis is usually made following an analysis of the clinical, neuroimaging, and electrophysiologic features. Treatment of metastatic plexopathy has included surgical resection of tumor in selected cases, radiotherapy to the plexus, systemic chemotherapy, interventional pain management procedures, and symptomatic treatment. These measures often offer temporary (months) relief or improvement. Physicians treating these patients should focus on effective management of pain and prevention of complications of immobility produced by the neuromuscular dysfunction.

REFERENCES

  • 1 Kamenova B, Braverman A S, Schwartz M et al.. Effective treatment of the brachial plexus syndrome in breast cancer patients by early detection and control of loco-regional metastases with radiation or systemic therapy.  Int J Clin Oncol. 2009;  14(3) 219-224
  • 2 Kori S H, Foley K M, Posner J B. Brachial plexus lesions in patients with cancer: 100 cases.  Neurology. 1981;  31(1) 45-50
  • 3 Jaeckle K A, Young D F, Foley K M. The natural history of lumbosacral plexopathy in cancer.  Neurology. 1985;  35(1) 8-15
  • 4 Pierce S M, Recht A, Lingos T I et al.. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer.  Int J Radiat Oncol Biol Phys. 1992;  23(5) 915-923
  • 5 Powell S, Cooke J, Parsons C. Radiation-induced brachial plexus injury: follow-up of two different fractionation schedules.  Radiother Oncol. 1990;  18 213-220
  • 6 Sheldon T, Hayes D F, Cady B et al.. Primary radiation therapy for locally advanced breast cancer.  Cancer. 1987;  60(6) 1219-1225
  • 7 Pancoast H K. Superior pulmonary sulcus tumor.  JAMA. 1932;  99 1391-1396
  • 8 Pettigrew L C, Glass J P, Maor M, Zornoza J. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer.  Arch Neurol. 1984;  41(12) 1282-1285
  • 9 Ebner I, Anderl H, Mikuz G, Frommhold H. Plexus neuropathy: tumor infiltration or radiation damage.  Rofo. 1990;  152(6) 662-666
  • 10 Dalmau J, Graus F, Marco M. ‘Hot and dry foot’ as initial manifestation of neoplastic lumbosacral plexopathy.  Neurology. 1989;  39(6) 871-872
  • 11 Taylor B V, Kimmel D W, Krecke K N, Cascino T L. Magnetic resonance imaging in cancer-related lumbosacral plexopathy.  Mayo Clin Proc. 1997;  72(9) 823-829
  • 12 Qayyum A, MacVicar A D, Padhani A R, Revell P, Husband J E. Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques.  Radiology. 2000;  214(3) 837-842
  • 13 Thyagarajan D, Cascino T, Harms G. Magnetic resonance imaging in brachial plexopathy of cancer.  Neurology. 1995;  45(3 Pt 1) 421-427
  • 14 Wouter van Es H, Engelen A M, Witkamp T D, Ramos L M, Feldberg M A. Radiation-induced brachial plexopathy: MR imaging.  Skeletal Radiol. 1997;  26(5) 284-288
  • 15 Moskovic E, Curtis S, A'Hern R P, Harmer C L, Parsons C. The role of diagnostic CT scanning of the brachial plexus and axilla in the follow-up of patients with breast cancer.  Clin Oncol (R Coll Radiol). 1992;  4(2) 74-77
  • 16 Ahmad A, Barrington S, Maisey M, Rubens R D. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients.  Br J Cancer. 1999;  79(3-4) 478-482
  • 17 Du R, Auguste K I, Chin C T et al.. Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders.  J Neurosurg. 2010;  112(2) 362-371
  • 18 Thomas J E, Cascino T L, Earle J D. Differential diagnosis between radiation and tumor plexopathy of the pelvis.  Neurology. 1985;  35(1) 1-7
  • 19 Sundaresan N, DiGiacinto G V. Antitumor and antinociceptive approaches to control cancer pain.  Med Clin North Am. 1987;  71(2) 329-348
  • 20 Kahn Jr C E, Messersmith R N, Samuels B L. Brachial plexopathy as a complication of intraarterial cisplatin chemotherapy.  Cardiovasc Intervent Radiol. 1989;  12(1) 47-49
  • 21 Lachance D H, O'Neill B P, Harper Jr C M, Banks P M, Cascino T L. Paraneoplastic brachial plexopathy in a patient with Hodgkin's disease.  Mayo Clin Proc. 1991;  66(1) 97-101
  • 22 Greenfield M M, Stark F M. Post-irradiation neuropathy.  Am J Roentgenol Radium Ther. 1948;  60 617-622
  • 23 Cavanagh J B. Prior x-irradiation and the cellular response to nerve crush: duration of effect.  Exp Neurol. 1968;  22(2) 253-258
  • 24 Bradley W G, Fewings J D, Cumming W J, Harrison R M. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat.  J Neurol Sci. 1977;  31(1) 63-82
  • 25 Basso-Ricci S, della Costa C, Viganotti G, Ventafridda V, Zanolla R. Report on 42 cases of postirradiation lesions of the brachial plexus and their treatment.  Tumori. 1980;  66(1) 117-122
  • 26 Bagley F H, Walsh J W, Cady B, Salzman F A, Oberfield R A, Pazianos A G. Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer.  Cancer. 1978;  41(6) 2154-2157
  • 27 Harper Jr C M, Thomas J E, Cascino T L, Litchy W J. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG.  Neurology. 1989;  39(4) 502-506
  • 28 Killer H E, Hess K. Natural history of radiation-induced brachial plexopathy compared with surgically treated patients.  J Neurol. 1990;  237(4) 247-250
  • 29 Mondrup K, Olsen N K, Pfeiffer P, Rose C. Clinical and electrodiagnostic findings in breast cancer patients with radiation-induced brachial plexus neuropathy.  Acta Neurol Scand. 1990;  81(2) 153-158
  • 30 Olsen N K, Pfeiffer P, Mondrup K, Rose C. Radiation-induced brachial plexus neuropathy in breast cancer patients.  Acta Oncol. 1990;  29(7) 885-890
  • 31 Ashenhurst E M, Quartey G R, Starreveld A. Lumbo-sacral radiculopathy induced by radiation.  Can J Neurol Sci. 1977;  4(4) 259-263
  • 32 Johansson S, Svensson H, Larsson L G, Denekamp J. Brachial plexopathy after postoperative radiotherapy of breast cancer patients—a long-term follow-up.  Acta Oncol. 2000;  39(3) 373-382
  • 33 Fathers E, Thrush D, Huson S M, Norman A. Radiation-induced brachial plexopathy in women treated for carcinoma of the breast.  Clin Rehabil. 2002;  16(2) 160-165
  • 34 Forquer J A, Fakiris A J, Timmerman R D et al.. Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites.  Radiother Oncol. 2009;  93(3) 408-413
  • 35 Gałecki J, Hicer-Grzenkowicz J, Grudzień-Kowalska M, Michalska T, Załucki W. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer—a review.  Acta Oncol. 2006;  45(3) 280-284
  • 36 Boyaciyan A, Oge A E, Yazici J, Aslay I, Baslo A. Electrophysiological findings in patients who received radiation therapy over the brachial plexus: a magnetic stimulation study.  Electroencephalogr Clin Neurophysiol. 1996;  101(6) 483-490
  • 37 Roth G, Magistris M R, Le Fort D, Desjacques P, Della Santa D. Post-radiation branchial plexopathy. Persistent conduction block. Myokymic discharges and cramps.  Rev Neurol (Paris). 1988;  144(3) 173-180
  • 38 Glantz M J, Burger P C, Friedman A H, Radtke R A, Massey E W, Schold Jr S C. Treatment of radiation-induced nervous system injury with heparin and warfarin.  Neurology. 1994;  44(11) 2020-2027
  • 39 Pritchard J, Anand P, Broome J et al.. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy.  Radiother Oncol. 2001;  58(3) 279-286
  • 40 Tung T H, Liu D Z, Mackinnon S E. Nerve transfer for elbow flexion in radiation-induced brachial plexopathy: a case report.  Hand (N Y). 2009;  4(2) 123-128
  • 41 Tung T H, Martin D Z, Novak C B, Lauryssen C, Mackinnon S E. Nerve reconstruction in lumbosacral plexopathy. Case report and review of the literature.  J Neurosurg. 2005;  102(1, Suppl) 86-91
  • 42 Teixeira M J, Fonoff E T, Montenegro M C. Dorsal root entry zone lesions for treatment of pain-related to radiation-induced plexopathy.  Spine (Phila Pa 1976). 2007;  32(10) E316-E319

Kurt A JaeckleM.D. 

Department of Neurology and Oncology, Mayo Clinic Florida

4500 San Pablo Road, Jacksonville, FL 32224

Email: jaeckle.kurt@mayo.edu