Brachial plexopathy in apical non-small cell lung cancer treated with definitive radiation: dosimetric analysis and clinical implications.

Abstract

PURPOSE:

Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients.

METHODS AND MATERIALS:

Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received ≥50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines.

RESULTS:

Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received ≤78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving ≥1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively.

CONCLUSIONS:

RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of patients.

• Authors: Michael J Eblan, Michael N Corradetti, J Nicholas Lukens, Eric Xanthopoulos, Nandita Mitra, John P Christodouleas, Surbhi Grover, Annemarie T Fernandes, Corey J Langer, Tracey L Evans, James Stevenson, Ramesh Rengan, Smith Apisarnthanarax
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 85 Issue 1 Pg. 175-81 (Jan 01 2013) ISSN: 1879-355X [Electronic] United States
• PMID: 22658442 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Brachial Plexus (radiation effects)
• Brachial Plexus Neuropathies (epidemiology, etiology, mortality)
• Carcinoma, Non-Small-Cell Lung (complications, pathology, radiotherapy)
• Chemoradiotherapy (adverse effects)
• Disease-Free Survival
• Female
• Humans
• Lung Neoplasms (complications, pathology, radiotherapy)
• Male
• Middle Aged
• Radiation Injuries (complications)
• Radiotherapy Dosage
• Retrospective Studies