Gopal Nikhil, Chopra Harman, Kumar Arvind Senthil, Suri Pranamya, Muneio Eric Paul, Chhatre Akhil
Department of Physical Medicine & Rehabilitation, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
Interv Pain Med. 2023 Sep 29;2(4):100281. doi: 10.1016/j.inpm.2023.100281. eCollection 2023 Dec.
In males, prostate cancer is the second most diagnosed cancer worldwide and the sixth leading cause of cancer death. Radiation therapy is a common treatment modality for prostate cancer but carries a multitude of adverse effects, ranging from radiation cystitis to post-radiation neuropathy. Proton beam therapy has gained attention as a valuable alternative, due to its improved precision with targeted dose delivery and reduced toxicity. However, the risk for radiation-induced complications, such as radiation-induced lumbar radiculopathy, is not fully understood and requires further investigation.
We present a 68-year-old man with delayed-onset lumbosacral polyradiculitis following proton precision beam therapy for localized prostate cancer. The patient underwent proton therapy treatment for the prostate and seminal vesicles with favorable results and tumor remission. However, five months after completing radiation therapy, the patient presented with chronic lower extremity pain, weakness, and bilateral lower extremity paresthesias. MRI showed diffuse hyperintensity of bilateral L5-S3 nerve roots and an intramuscular edema-like signal involving the bilateral obturator externus and internus muscles, likely due to radiation. Additionally, EMG findings suggested the presence of chronic bilateral L5 radiculopathy.
The clinical manifestation of delayed-onset radiation-induced lumbosacral plexopathy is a rare and uncommon complication of external beam radiation therapy that presents as radicular or myelopathic symptoms based on the location and severity of the inflammation. This case highlights the need for continued follow-up post-radiation and emphasizes the need for a comprehensive review of the oncological history of cancer patients.
在男性中，前列腺癌是全球第二大最常被诊断出的癌症，也是癌症死亡的第六大主要原因。放射治疗是前列腺癌的一种常见治疗方式，但会带来多种不良反应，从放射性膀胱炎到放射后神经病变不等。质子束治疗作为一种有价值的替代方法受到了关注，因为它在靶向剂量递送方面提高了精度且降低了毒性。然而，辐射诱发并发症的风险，如辐射诱发的腰骶神经根病，尚未完全了解，需要进一步研究。
我们报告一名68岁男性，在接受质子精确束治疗局限性前列腺癌后出现迟发性腰骶部多神经根炎。该患者接受了前列腺和精囊的质子治疗，效果良好且肿瘤缓解。然而，在完成放射治疗五个月后，患者出现慢性下肢疼痛、无力和双侧下肢感觉异常。磁共振成像显示双侧L5 - S3神经根弥漫性高信号，以及双侧闭孔外肌和闭孔内肌出现肌内水肿样信号，可能是由于辐射所致。此外，肌电图检查结果提示存在慢性双侧L5神经根病。
迟发性辐射诱发腰骶丛神经病的临床表现是外照射放疗一种罕见且不常见的并发症，根据炎症的部位和严重程度表现为神经根性或脊髓病性症状。本病例强调了放疗后持续随访的必要性，并强调了对癌症患者肿瘤病史进行全面回顾的必要性。
