Basso-Ricci S, della Costa C, Viganotti G, Ventafridda V, Zanolla R
Tumori. 1980 Feb;66(1):117-22. doi: 10.1177/030089168006600113.
Here we report 42 cases of postirradiation lesions of the brachial nerve plexus in patients treated with radiotherapy after radical mastectomy. These lesions usually appeared at least 1 year after treatment, and motorial disturbances always developed, even if initially they may have been absent. A comparison of the case material indicates that a reduction in the dose administered to the supraclavicular region and exclusion of the axillary region from the treatment resulted in a significant reduction in the incidence of these lesions. In fact, in a group of 490 patients treated by the old radiotherapy method at the Istituto Nazionale Tumori of Milan (i.e., administration of 6000 rad to the brachial nerve plexus), 16 cases of lesions at this plexus were observed. In a group of 200 patients treated instead with a new method (i.e., administration of 4900 rad to the brachial nerve plexus and exclusion of the axillary region), no nerve lesions were observed, with significance levels, according to Fisher's test, less than 0.9%. Since radiolesions at the brachial nerve plexus have a very bad prognosis with regard to functioning of the limb and physiotherapy is of little help, this new therapeutic method is very useful, and it is not accompanied by an increase in the number of local recurrences as compared to the old method.
在此，我们报告了42例在根治性乳房切除术后接受放疗的患者发生的臂丛神经放疗后损伤病例。这些损伤通常在治疗后至少1年出现，并且总会出现运动障碍，即使最初可能没有。病例材料的比较表明，减少锁骨上区域的照射剂量并将腋窝区域排除在治疗范围之外，可使这些损伤的发生率显著降低。事实上，在米兰国家肿瘤研究所采用旧放疗方法治疗的490例患者（即对臂丛神经给予6000拉德照射）中，观察到16例该神经丛损伤病例。而在采用新方法治疗的200例患者（即对臂丛神经给予4900拉德照射并排除腋窝区域）中，未观察到神经损伤病例，根据费舍尔检验，显著性水平小于0.9%。由于臂丛神经放射性损伤对肢体功能的预后非常差，且物理治疗帮助不大，这种新的治疗方法非常有用，并且与旧方法相比，它不会导致局部复发数量增加。
