Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review

Figures & data

Figure 1.  Schematic representation of the brachial plexus in relation to the borders of irradiated field and operated area.

Table I.  The incidence of radiation-induced brachial plexopathy (RIBP) in respect to dose per fraction and total dose to brachial plexus.

Author	No. of patients	Median Follow-up [years]	Dose per fraction [Gy]	Total dose [Gy]	RIBP %	BED^1
Stoll [16]	a) 33	2.5	4.58	55	73	90
	b) 84	2.5	4.25	51	15	80
	c) 139	2.5	4.35	43.5	10	69
Johansson [18]	71	34	3.5^2	57	63	78
Barr [20]	250	3	3.4	51	2.4	69
Powell [21]	a) 338	5.5	3	45	5.9	56
	b) 111	5.5	1.8	54	1	51
Basso-Ricci [22]	490	5	2^3	60^3	3.2	60^3
Bajrovic [23]	140	8	2.6	52	14	59.8
Fairchild [26]	1142	8	2.5	40	<1	45
Livsey [31]	1665	5	2.27	34	no	36
Ragaz [9]	164	12.5	2.19	35	no	36.7
Olsen [32]	128	4	2.17	54.25	15	57
Delouche [24]	117	10	2	60	1.7	60
Fowble [14]	697	10	2	50	<1	50
Pierce [15]	724	6.5	2	50	0.4	50

¹BED – Biological Equivalent Dose, α/β = 2 Gy^[4,21].

²Average dose (combination of 17 treatments of 1.8 Gy, 3.4, 5.2 Gy).

³Fraction and total dose were higher due to field overlap.

Figure 2.  Relationship between incidences of radiation-induced brachial plexopathy (RIBP) and biological effective dose (BED). The reference line indicates the 5% level of RIBP.

Table II.  The incidence of radiation-induced brachial plexopathy (RIBP) in respect to total axillary radiation dose (TD) and chemotherapy CT.

Author	RIBP/ number of patients %	TD ≤ 50 Gy no CT %	TD ≤ 50 Gy with CT %	TD ≥ 50 Gy no CT %	TD ≥ 50 Gy with CT %
Pierce [15]	20/1117(1.8)	0.4	3.7; p = 0.0002	3.2	7.9; p = NS
Olsen [32]	19/128*(15)	–	–	1.6	13; p = 0.01

*Number of patients who presented for neurological evaluation of 161 recurrence-free patients.

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