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Radiation-Induced Brachial Plexopathy

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Radiation-induced brachial plexopathy is a short, long-term or late stage side effect of radiation causing damage to surrounding tissue. According to research, more than half of all cancer patients will undergo radiation therapy. 

I am a long-term cancer survivor who has written about radiation fibrosis many times on PeopleBeatingCancer.org. But I have skipped over Radiation-induced brachial plexopathy only because my radiation damage is in my neck and my waist and below.

I’m writing about radiation-induced brachial plexopathy today because I figured out that this side effects is the same as my radiation-induced xerostomia, dysphagia, plexopathy, etc. just in a different part of the body.


What are the symptoms of radiation-induced brachial plexopathy?

  1. Pain: Persistent or intermittent pain in the shoulder, arm, or hand is a common symptom of RIBP. The pain may be dull, aching, or sharp, and it can vary in intensity.
  2. Weakness: Weakness in the muscles of the affected arm may occur, making it difficult to perform everyday tasks such as lifting objects or reaching overhead.
  3. Numbness and Tingling: Numbness, tingling, or a pins-and-needles sensation in the arm, shoulder, or hand may develop. This can affect sensation and dexterity.
  4. Loss of Coordination: Coordination may be affected, leading to clumsiness or difficulty performing fine motor tasks with the hand.
  5. Muscle Atrophy: Over time, the muscles in the affected arm may become smaller (atrophy) due to weakness and lack of use.
  6. Restricted Range of Motion: Stiffness and decreased flexibility in the shoulder joint may occur, limiting the range of motion in the affected arm.
  7. Swelling: Swelling in the arm, hand, or shoulder may develop due to lymphedema, a condition characterized by fluid retention.
  8. Changes in Sensation: Changes in sensation, such as hypersensitivity to touch or temperature changes, may occur.

Each and every therapy discussed below for radiation-induced brachial plexopathy is a therapy for radiation damage. The challenge is that some therapies don’t work well, some are timing related (undergo HBOT as soon as you can post radiation therapy) and some are slow. I have been having weekly acupuncture sessions for over a year now. I am making progress but slowly.

 

All to say, there are therapies, both conventional and evidence-based non-conventional, identifying therapies that work for you may require time and effort.

If you would like to learn more about radiation-induced brachial plexopathy therapies email me at David.PeopleBeatingCancer@gmail.com 

Good luck,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Hyperbaric Oxygen Therapy and Radiation-Induced Injuries

“Irradiated tissue responses well delineated in hyperbaric ORN studies are a more modern conceptualization of HBO2 effects and potential value to patients. As ever increasing sophistication of basic science capabilities to delineate cellular and tissue responses occur, HBO2 has been found to have effects beyond oxygenation. As HBO2 increases tissue oxygenation and improves blood flow, it also effects cellular responses for healing. However interesting these basic science mechanism are to consider, modern evidence based recommendations are also based upon clinical evidence and this is where better data registries will make an impact. The cumulative patient and tissue improvements seen in ORN and other post irradiation changes demonstrate the additional, adjunctive value of HBO2 in other similarly damaged tissue states…”

Enhanced acupuncture therapy for radiotherapy-related neuropathic pain in patients with gynecologic cancer: a report of two cases and brief review

“The results of this study showed that acupuncture might be promising for controlling the RRNP in patients with cancer, especially who were intolerant or unresponsive to medications…”

Pulsed Radiofrequency Ablation: An Alternative Treatment Modality for Radiation-Induced Brachial Plexopathy

“ABSTRACT- Radiation therapy is used as a form of treatment for various neoplastic diseases. There are many potential adverse effects of this therapy, including radiation-induced neurotoxicity.

Radiation-induced brachial plexopathy (RIBP) may occur due to the fibrosis of neural and perineural soft tissues, leading to ischemic damage of the axons and Schwann cells. The dose of radiation exceeds 55 Gy in many patients who develop symptoms [1].

Current incidence in the United States is 1–2%, and RIBP is most commonly seen in patients who have undergone treatment for:

  • breast cancer,
  • lung cancer, or
  • lymphoma [1–3].

Common symptoms include:

  • numbness,
  • paresthesia,
  • dysesthesia, and
  • occasional numbness of the arm.

Pain is present in the shoulder and proximal arm and is typically mild to moderate in severity. Diagnosis is often made based on clinical presentation and evaluation of imaging to rule out concurrent malignant etiologies of the brachial plexus. Current recommended treatment includes physical therapy and medical management with anticonvulsants, tricyclic antidepressants, and selective serotonin-norepinephrine reuptake inhibitors…

Introduction- Radiation-induced brachial plexopathy (RIBP) is a potential complication that develops months to decades after radiotherapy for neoplastic disease, resulting in irreversible progressive neurological injury of the brachial plexus with the potential of developing complete limb paralysis [1]. The mean annual incidence ranges from 1.8% to 2.9%.

It is most commonly seen after radiotherapy for

  • lymphoma,
  • lung cancer,
  • or breast cancer at doses greater than 55 Gy total to the plexus [2–5].

Unfortunately, there are limited treatment options for these patients…

We chose to perform the block at the upper trunk of the brachial plexus at the supraclavicular level for a few reasons. Although the patient’s entire arm was painful, most of his pain was reported at the lateral aspect of the forearm extending down into the first two digits of his hand. This dermatomal area is covered primarily by the C6 nerve root, which contributes to the upper trunk of the brachial plexus at the supraclavicular level…

The underlying pathophysiology of RIBP is thought to be due to radiation-induced fibrosis of neural and perineural soft tissue. There is an imbalance of excessive inflammatory mediators and deficient antioxidant defenses leading to microvascular injury. The oxidative stress response becomes overburdened and fibrogenesis becomes possible, followed by ischemic damage to axons and Schwann cells [2]…

Symptoms include:

  • shoulder and proximal arm pain,
  • paresthesia,
  • dysesthesia,
  • and occasional arm numbness. 

The diagnosis of RIBP is made based on clinical presentation and imaging to rule out other causes such as invasion of the brachial plexus by a tumor. Normally, RIBP is diagnosed years after radiation therapy [6,7]…

Treatment of RIBP is focused on management of neuropathic pain with gabapentanoids and antidepressants. Other treatments described in the literature include:

  • corticosteroids,
  • vitamin E,
  • pentoxifylline,
  • and hyperbaric oxygen therapy [8,9].

Due to the rarity of this disease entity, large randomized controlled data are lacking to support any specific treatment. We did not use hyperbaric oxygen because it was not available at our facility…

PRF is a form of neuromodulation that has been available for the past 20 years, with well over 200 publications describing it as an acceptable technique to treat focal pain without destruction of the neural target [11]. Although the precise mechanism has not been fully established, this neuromodulation technique has an established safety profile, and we felt that we could effectively deliver a low-risk treatment under ultrasonic guidance…

 

 

 

 

 

 

 

 

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