Neurological Manifestations of Neoplastic and Radiation-Induced Plexopathies

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. Regardless of the location, neoplastic plexopathy is often characterized by severe, unrelenting pain. Later, weakness and focal sensory disturbances occur in the distribution of plexus involvement. In previously treated patients, the main differential diagnostic consideration is radiation-induced plexopathy. Treatment of metastatic plexopathy is palliative and includes radiotherapy to the tumor mass, chemotherapy, and symptomatic treatment. In selected cases, subtotal surgical resection of the tumor may be warranted. The response to therapy is modest and generally short-lived. Efforts should be made to provide adequate pain control, maximize remaining neurological function, and prevent complications of immobility produced by the neuromuscular dysfunction.

KEYWORDS

Neoplastic plexopathy - metastatic plexopathy

REFERENCES

• 1 Kori S H, Foley K M, Posner J B. Brachial plexus lesions in patients with cancer: 100 cases.  Neurology. 1981;  31 45-50
• 2 Jaeckle K A, Young D F, Foley K M. The natural history of lumbosacral plexopathy in cancer.  Neurology. 1985;  35 8-15
• 3 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;  23 915-923
• 4 Powell S, Cooke J, Parsons C. Radiation-induced brachial plexus injury: follow-up of two different fractionation schedules.  Radiother Oncol. 1990;  18 213-220
• 5 Sheldon T, Hayes D F, Cady B et al.. Primary radiation therapy for locally advanced breast cancer.  Cancer. 1987;  60 1219-1225
• 6 Pancoast H K. Superior pulmonary sulcus tumor.  JAMA. 1932;  99 1391-1396
• 7 Pettigrew L C, Glass J P, Maor M et al.. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer.  Arch Neurol. 1984;  41 1282-1285
• 8 Ebner I, Anderl H, Mikuz G et al.. [Plexus neuropathy: tumor infiltration or radiation damage].  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1990;  152 662-666
• 9 Dalmau J, Graus F, Marco M. “Hot and dry foot” as initial manifestation of neoplastic lumbosacral plexopathy.  Neurology. 1989;  39 871-872
• 10 Taylor B V, Kimmel D W, Krecke K N et al.. Magnetic resonance imaging in cancer-related lumbosacral plexopathy.  Mayo Clin Proc. 1997;  72 823-829
• 11 Qayyum A, MacVicar A D, Padhani A R et al.. Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques.  Radiology. 2000;  214 837-842
• 12 Thyagarajan D, Cascino T, Harms G. Magnetic resonance imaging in brachial plexopathy of cancer.  Neurology. 1995;  45 421-427
• 13 Wouter van Es H, Engelen A M, Witkamp T D et al.. Radiation-induced brachial plexopathy: MR imaging.  Skeletal Radiol. 1997;  26 284-288
• 14 Moskovic E, Curtis S, A'Hern R P et al.. 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 74-77
• 15 Ahmad A, Barrington S, Maisey M et al.. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients.  Br J Cancer. 1999;  79 478-482
• 16 Thomas J E, Cascino T L, Earle J D. Differential diagnosis between radiation and tumor plexopathy of the pelvis.  Neurology. 1985;  35 1-7
• 17 Sundaresan N, DiGiacinto G V. Antitumor and antinociceptive approaches to control cancer pain.  Med Clin North Am. 1987;  71 329-348
• 18 Kahn Jr C E, Messersmith R N, Samuels B L. Brachial plexopathy as a complication of intraarterial cisplatin chemotherapy.  Cardiovasc Intervent Radiol. 1989;  12 47-49
• 19 Lachance D H, O'Neill B P, Harper Jr C M et al.. Paraneoplastic brachial plexopathy in a patient with Hodgkin's disease.  Mayo Clin Proc. 1991;  66 97-101
• 20 Greenfield M M, Stark G M. Post-irradiation neuropathy.  AJR Am J Roentgenol. 1948;  60 617-622
• 21 Cavanagh J B. Prior x-irradiation and the cellular response to nerve crush: duration of effect.  Exp Neurol. 1968;  22 253-258
• 22 Bradley W G, Fewings J D, Cumming W J et al.. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat.  J Neurol Sci. 1977;  31 63-82
• 23 Basso-Ricci S, della Costa C, Viganotti G et al.. Report on 42 cases of postirradiation lesions of the brachial plexus and their treatment.  Tumori. 1980;  66 117-122
• 24 Bagley F H, Walsh J W, Cady B et al.. Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer.  Cancer. 1978;  41 2154-2157
• 25 Harper Jr C M, Thomas J E, Cascino T L et al.. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG.  Neurology. 1989;  39 502-506
• 26 Killer H E, Hess K. Natural history of radiation-induced brachial plexopathy compared with surgically treated patients.  J Neurol. 1990;  237 247-250
• 27 Mondrup K, Olsen N K, Pfeiffer P et al.. Clinical and electrodiagnostic findings in breast cancer patients with radiation-induced brachial plexus neuropathy.  Acta Neurol Scand. 1990;  81 153-158
• 28 Olsen N K, Pfeiffer P, Mondrup K et al.. Radiation-induced brachial plexus neuropathy in breast cancer patients.  Acta Oncol. 1990;  29 885-890
• 29 Ashenhurst E M, Quartey G R, Starreveld A. Lumbo-sacral radiculopathy induced by radiation.  Can J Neurol Sci. 1977;  4 259-263
• 30 Johansson S, Svensson H, Larsson L G et al.. Brachial plexopathy after postoperative radiotherapy of breast cancer patients-a long-term follow-up.  Acta Oncol. 2000;  39 373-382
• 31 Fathers E, Thrush D, Huson S M et al.. Radiation-induced brachial plexopathy in women treated for carcinoma of the breast.  Clin Rehabil. 2002;  16 160-165
• 32 Boyaciyan A, Oge A E, Yazici J et al.. Electrophysiological findings in patients who received radiation therapy over the brachial plexus: a magnetic stimulation study.  Electroencephalogr Clin Neurophysiol. 1996;  101 483-490
• 33 Roth G, Magistris M R, Le Fort D et al.. [Post-radiation brachial plexopathy. Persistent conduction block. Myokymic discharges and cramps].  Rev Neurol (Paris). 1988;  144 173-180
• 34 Glantz M J, Burger P C, Friedman A H et al.. Treatment of radiation-induced nervous system injury with heparin and warfarin.  Neurology. 1994;  44 2020-2027
• 35 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;  58 279-286
• 36 Kori S H. Diagnosis and management of brachial plexus lesions in cancer patients.  Oncology (Huntingt). 1995;  9 756-760