Olsen N K, Pfeiffer P, Johannsen L, Schrøder H, Rose C
Department of Neurology, Odense University Hospital, Denmark.
Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):43-9. doi: 10.1016/0360-3016(93)90171-q.
The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols.
One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen.
Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%).
The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus.
旨在评估按照丹麦乳腺癌协作组方案治疗的乳腺癌患者中放射性臂丛神经病变的发生率及临床表现。
对161例无复发的乳腺癌患者进行了检查，中位随访期为50个月（13 - 99个月），以评估放射性臂丛神经病变情况。全乳切除及腋窝淋巴结取样后，高危患者被随机分配至辅助治疗组。128例患者接受了术后放疗，5周内每日1次，每次2Gy，共50Gy。此外，其中82例患者接受了细胞毒性治疗（环磷酰胺、甲氨蝶呤和5-氟尿嘧啶），46例患者接受了他莫昔芬治疗。
接受放疗的患者中，分别有5%和9%发生了致残性和轻度放射性臂丛神经病变。接受细胞毒性治疗的患者（p = 0.04）以及年轻患者（p = 0.04）中，放射性臂丛神经病变更为常见。临床表现为感觉异常（100%）、感觉减退（74%）、无力（58%）、肌肉牵张反射减弱（47%）和疼痛（47%）。
臂丛神经对大分割剂量更敏感。建议分割剂量为2Gy或更低。细胞毒性治疗会增加放疗的损伤作用。年轻患者的周围神经似乎更易受损。放射性臂丛神经病变主要表现为臂丛神经的弥漫性损伤。
