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Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri

Year 2008, Volume: 23 Issue: 3, 147 - 152, 01.04.2008

Abstract

Radiation-induced lumbosacral plexopathy (RILP) is a rare but severely debilitating side effect of abdominopelvic irradiation, which is used in the management of a myriad of primary and metastatic tumors involving the abdominal, pelvic and retroperitoneal regions. Although the exact mechanism of RILP is not yet clearly elucidated, postulated mechanisms include radiation-induced vascular injury and radiation fibrosis leading to axonal damage and entrapment of nerves/small vessels, respectively. Effects of radiation are suggested to be correlated to the dose per fraction and total dose of radiation therapy (RT), use of radiosensitizing agents, RT technique, and concurrent administration of chemotherapy. Furthermore, the risk of RILP occurrence particularly increases with intracavitary and intraoperative brachytherapy applications. In the current review, we aimed to summarize the latest literature considering aspects of the pathophysiology, clinical features differential diagnosis, and treatment of this debilitating complication.

References

  • 1. Ashenhurst EM, Quartey GR, Starreveld A. Lumbosacral radiculopathy induced by radiation. Can J Neurol Sci 1977;4(4):259-63.
  • 2. Yadav RR. Radiation-›nduced lumbosacral plexopathy. http://www.emedicine.com/pmr/topic122.htm. 3. Yadav RR. Neoplastic lumbosacral plexopathy. http://www.emedicine.com/pmr/topic90.htm.
  • 4. Saphner T, Gallion HH, Van Nagell JR, Kryscio R, Patchell RA. Neurologic complications of cervical c a n c e r. A review of 2261 cases. Cancer 1989;64(5):1147-51.
  • 5. Stevens MJ, Gonet YM. Malignant psoas syndrome: recognition of an oncologic entity. Australas Radiol 1990;34(2):150-4.
  • 6. G e o rgiou A, Grigsby PW, Perez CA. Radiation induced lumbosacral plexopathy in gynecologic tumors: clinical findings and dosimetric analysis. Int J Radiat Oncol Biol Phys 1993;26(3):479-82.
  • 7. Liao Z, Komaki R, Milas L, Yuan C, Kies M, Chang JY, et al. A phase I clinical trial of thoracic radiotherapy and concurrent celecoxib for patients with unfavorable performance status inoperable/unresectable non-small cell lung cancer. Clin Cancer Res 2005;11(9):3342-8.
  • 8. Bradley WG, FewingsJD, Cumming WJ, Harrison RM. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat. J Neurol Sci 1977;31(1):63-82.
  • 9. Abu-Rustum NR, Rajbhandari D, Glusman S, Massad LS. Acute lower extremity paralysis following radiation therapy for cervical cancer. Gynecol Oncol 1999;75(1):152-4.
  • 10. Aho K, Sainio K. Late irradiation-induced lesions of the lumbosacral plexus. Neurology 1983;33(7):953-5.
  • 11. González-Caballero G, Arroyo-González R, VázquezPérez AV, de las Heras V, González-Gutiérrez JL. Lumbosacral plexopathy 15 years after radiotherapy for carcinoma of the cervix. [Article in Spanish] Rev Neurol 2000;30(1):97. [Abstract]
  • 12. Numata K, Ito M, Uchiyama S, Kobayashi I, Takemiya T, Maruyama S. A case of delayed radiation lumbo-sacral plexopathy. [Article in Japanese] No To Shinkei 1990;42(7):629-33. [Abstract]
  • 13. Videtic GM, Venkatesan VM. Hyperbaric oxygen corrects sacral plexopathy due to osteoradionecrosis appearing 15 years after pelvic irradiation. Clin Oncol (R Coll Radiol) 1999;11(3):198-9.
  • 14. Dahele M, Davey P, Reingold S, Shun Wong C. Radiation-induced lumbo-sacral plexopathy (RILSP): an important enigma. Clin Oncol (R Coll Radiol) 2006;18(5):427-8.
  • 15.Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology 1985;35(1):8-15.
  • 16.Jaeckle KA. Neurological manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol 2004;24(4):385-93.
  • 17. Pettigrew LC, Glass JP, Maor M, Zornoza J. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer. Arch Neurol 1984;41(12):1282-5.
  • 18.Iglicki F, Coffin B, Ille O, Flourié B, Amarenco G, Lémann M, et al. Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case. Dis Colon Rectum 1996;39(4):465-7.
  • 19. Taylor BV, Kimmel DW, Krecke KN, Cascino TL. Magnetic resonance imaging in cancer-related lumbosacral plexopathy. Mayo Clin Proc 1997;72(9):823-9.
  • 20. Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology 1985;35(1):1-7.
  • 21. Wilbourn AJ. Electrodiagnosis of plexopathies. Neurol Clin 1985;3(3):511-29.
  • 22. Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiationinduced brachial plexopathy. Radiother Oncol 2001;58(3):279-86.
  • 23. Glantz MJ, Burger PC, Friedman AH, Radtke RA, Massey EW, Schold SC Jr. Treatment of radiationinduced nervous system injury with heparin and warfarin. Neurology 1994;44(11):2020-7.

Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri

Year 2008, Volume: 23 Issue: 3, 147 - 152, 01.04.2008

Abstract

Radyasyona bağlı lumbosakral pleksus hasarı, karın, pelvis ve retroperiton bölgesinden köken alan primer tümörlerin veya bu bölgeleri tutan metastatik tümörlerin radyoterapisi (RT) ardından ender görülen, hasta yaşam kalitesini olumsuz yönde etkileyen bir yan etkidir. Radyasyona bağlı lumbosakral pleksus hasarının oluşum nedenleri tam olarak açıklığa kavuşturulamamış olmasa da öne sürülen mekanizmalar akson hasarına neden olan radyasyon nedenli vasküler hasar ve radyasyon fibrozisi sonrası vasküler yapılar ve sinirlerin sıkışması şeklinde açıklanmaktadır. Klinik tablonun gelişiminde etkisi olabilecek faktörler, fraksiyon büyüklüğü ve toplam radyasyon dozu, RT tekniği, radyasyon duyarlaştırıcılarının kullanımı, eşzamanlı kemoterapi uygulanması ve özellikle intraoperatif veya intrakaviter RT şeklinde bildirilmektedir. Bu yazıda, oldukça nadir bir klinik durum olan radyasyona bağlı lumbosakral pleksus hasarının patofizyolojik ve klinik özellikleri, ayırıcı tanıda yer alan hastalıklar ve tedavi seçenekleri son literatür bilgileri ışığında özetlendi.

References

  • 1. Ashenhurst EM, Quartey GR, Starreveld A. Lumbosacral radiculopathy induced by radiation. Can J Neurol Sci 1977;4(4):259-63.
  • 2. Yadav RR. Radiation-›nduced lumbosacral plexopathy. http://www.emedicine.com/pmr/topic122.htm. 3. Yadav RR. Neoplastic lumbosacral plexopathy. http://www.emedicine.com/pmr/topic90.htm.
  • 4. Saphner T, Gallion HH, Van Nagell JR, Kryscio R, Patchell RA. Neurologic complications of cervical c a n c e r. A review of 2261 cases. Cancer 1989;64(5):1147-51.
  • 5. Stevens MJ, Gonet YM. Malignant psoas syndrome: recognition of an oncologic entity. Australas Radiol 1990;34(2):150-4.
  • 6. G e o rgiou A, Grigsby PW, Perez CA. Radiation induced lumbosacral plexopathy in gynecologic tumors: clinical findings and dosimetric analysis. Int J Radiat Oncol Biol Phys 1993;26(3):479-82.
  • 7. Liao Z, Komaki R, Milas L, Yuan C, Kies M, Chang JY, et al. A phase I clinical trial of thoracic radiotherapy and concurrent celecoxib for patients with unfavorable performance status inoperable/unresectable non-small cell lung cancer. Clin Cancer Res 2005;11(9):3342-8.
  • 8. Bradley WG, FewingsJD, Cumming WJ, Harrison RM. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat. J Neurol Sci 1977;31(1):63-82.
  • 9. Abu-Rustum NR, Rajbhandari D, Glusman S, Massad LS. Acute lower extremity paralysis following radiation therapy for cervical cancer. Gynecol Oncol 1999;75(1):152-4.
  • 10. Aho K, Sainio K. Late irradiation-induced lesions of the lumbosacral plexus. Neurology 1983;33(7):953-5.
  • 11. González-Caballero G, Arroyo-González R, VázquezPérez AV, de las Heras V, González-Gutiérrez JL. Lumbosacral plexopathy 15 years after radiotherapy for carcinoma of the cervix. [Article in Spanish] Rev Neurol 2000;30(1):97. [Abstract]
  • 12. Numata K, Ito M, Uchiyama S, Kobayashi I, Takemiya T, Maruyama S. A case of delayed radiation lumbo-sacral plexopathy. [Article in Japanese] No To Shinkei 1990;42(7):629-33. [Abstract]
  • 13. Videtic GM, Venkatesan VM. Hyperbaric oxygen corrects sacral plexopathy due to osteoradionecrosis appearing 15 years after pelvic irradiation. Clin Oncol (R Coll Radiol) 1999;11(3):198-9.
  • 14. Dahele M, Davey P, Reingold S, Shun Wong C. Radiation-induced lumbo-sacral plexopathy (RILSP): an important enigma. Clin Oncol (R Coll Radiol) 2006;18(5):427-8.
  • 15.Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology 1985;35(1):8-15.
  • 16.Jaeckle KA. Neurological manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol 2004;24(4):385-93.
  • 17. Pettigrew LC, Glass JP, Maor M, Zornoza J. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer. Arch Neurol 1984;41(12):1282-5.
  • 18.Iglicki F, Coffin B, Ille O, Flourié B, Amarenco G, Lémann M, et al. Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case. Dis Colon Rectum 1996;39(4):465-7.
  • 19. Taylor BV, Kimmel DW, Krecke KN, Cascino TL. Magnetic resonance imaging in cancer-related lumbosacral plexopathy. Mayo Clin Proc 1997;72(9):823-9.
  • 20. Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology 1985;35(1):1-7.
  • 21. Wilbourn AJ. Electrodiagnosis of plexopathies. Neurol Clin 1985;3(3):511-29.
  • 22. Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiationinduced brachial plexopathy. Radiother Oncol 2001;58(3):279-86.
  • 23. Glantz MJ, Burger PC, Friedman AH, Radtke RA, Massey EW, Schold SC Jr. Treatment of radiationinduced nervous system injury with heparin and warfarin. Neurology 1994;44(11):2020-7.
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Erkan Topkan This is me

Hüseyin Cem Önal This is me

Ali Aydın Yavuz This is me

Melek Nur Yavuz This is me

Publication Date April 1, 2008
Published in Issue Year 2008 Volume: 23 Issue: 3

Cite

APA Topkan, E., Önal, H. C., Yavuz, A. A., Yavuz, M. N. (2008). Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri. Türk Onkoloji Dergisi, 23(3), 147-152.
AMA Topkan E, Önal HC, Yavuz AA, Yavuz MN. Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri. Türk Onkoloji Dergisi. April 2008;23(3):147-152.
Chicago Topkan, Erkan, Hüseyin Cem Önal, Ali Aydın Yavuz, and Melek Nur Yavuz. “Radyasyona bağlı Lumbosakral Pleksus hasarının Patofizyolojisi Ve Tedavi seçenekleri”. Türk Onkoloji Dergisi 23, no. 3 (April 2008): 147-52.
EndNote Topkan E, Önal HC, Yavuz AA, Yavuz MN (April 1, 2008) Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri. Türk Onkoloji Dergisi 23 3 147–152.
IEEE E. Topkan, H. C. Önal, A. A. Yavuz, and M. N. Yavuz, “Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri”, Türk Onkoloji Dergisi, vol. 23, no. 3, pp. 147–152, 2008.
ISNAD Topkan, Erkan et al. “Radyasyona bağlı Lumbosakral Pleksus hasarının Patofizyolojisi Ve Tedavi seçenekleri”. Türk Onkoloji Dergisi 23/3 (April 2008), 147-152.
JAMA Topkan E, Önal HC, Yavuz AA, Yavuz MN. Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri. Türk Onkoloji Dergisi. 2008;23:147–152.
MLA Topkan, Erkan et al. “Radyasyona bağlı Lumbosakral Pleksus hasarının Patofizyolojisi Ve Tedavi seçenekleri”. Türk Onkoloji Dergisi, vol. 23, no. 3, 2008, pp. 147-52.
Vancouver Topkan E, Önal HC, Yavuz AA, Yavuz MN. Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri. Türk Onkoloji Dergisi. 2008;23(3):147-52.