Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):175-81. doi: 10.1016/j.ijrobp.2012.03.051. Epub 2012 Jun 1.
Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients.
Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received ≥50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines.
Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received ≤78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving ≥1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively.
RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of patients.
在接受根治性放射治疗的患者中，有关臂丛神经病（RIBP）在顶部非小细胞肺癌（NSCLC）中的临床意义的数据有限。我们报告了顶部 NSCLC 患者中 RIBP 和肿瘤相关臂丛神经病（TRBP）的发生率以及与剂量相关的参数。
对接受≥50 Gy 根治性常规分割放射或放化疗的原发性上叶或上纵隔淋巴结疾病的 NSCLC 患者的图表进行了回顾性审查，以确定是否存在臂丛神经病，并将其分为 RIBP、TRBP 或与创伤相关的臂丛神经病。根据放射治疗肿瘤学组图谱指南，对同侧臂丛神经（IBP）进行了剂量学数据采集。
共确定了 80 例患者，中位随访和生存时间分别为 17.2 和 17.7 个月。中位处方剂量为 66.6 Gy（范围 50.4-84.0），71%的患者接受了同期化疗。5 例患者出现 RIBP，在考虑死亡竞争风险的情况下，估计 3 年发生率为 12%。7 例患者发生 TRBP（估计 3 年发生率为 13%），占局部区域复发患者的 24%。发生 TRBP 的患者中，3 级臂丛神经病更为常见（57%比 20%）。IBP 接受≤78 Gy 的患者未发生 RIBP。在多变量竞争风险分析中，IBP V76 接受≥1 cc 和原发性肿瘤失败的患者发生 RIBP 和 TRBP 的风险比最高。
在接受根治性剂量放射治疗的顶部 NSCLC 肿瘤患者中，RIBP 是一种相对罕见的并发症，而发生原发性肿瘤失败的患者发生严重 TRBP 的风险很高。这些发现表明，在该患者人群中，通过适当剂量的放射治疗控制原发性肿瘤的重要性大于发生 RIBP 的风险。
