Evaluation and Management of Radiation-Induced Plexopathies

Purpose of Review The purpose of the review is to detail the pathophysiology, clinical signs and symptoms, and evaluation and management of patients with radiation-induced plexopathy (RIP). The specific cancer types, radiation treatment techniques, and the associated plexus neuroanatomy most susceptible to injury will be discussed. Recent Findings The latest research has not demonstrated a way to predict which patients will develop RIP. There is, however, a strong correlation to dosing, anatomical exposure, and pattern of damage and symptomatology. While there is no cure for RIP, advances in radiation delivery techniques have, for the most part, effectively minimized plexus exposure and thus the incidence and severity of RIP. Various surgical and nonsurgical therapies have been described with largely disappointing results. Some interventions, such as surgically implanted diaphragmatic pacemakers to treat hemidiaphragmatic paralysis, the use of ultrasound, and/or electromyography-guided botox injections to treat hypertonic muscles, are helpful in some cases. Advances in imaging techniques have helped to more accurately determine whether developing neurologic symptoms are due to RIP or neoplasm. Summary Patients who receive high-dose radiation therapy that involves one of the body plexuses are at risk for developing RIP. Unfortunately, predicting the severity, time course of symptoms, and progression of RIP remains elusive. There is a growing awareness among the healthcare community of the acute and late effects of radiation therapy, specifically radiation-induced plexopathy. Because there is no meaningful way to slow or reverse the progression of RIP, management is largely symptomatic. Patients should be comprehensively evaluated, followed closely, and educated on the chronic and progressive nature of RIP. A multidisciplinary approach that involves multiple clinicians such as physiatrists, physical therapists, occupational therapists, lymphedema management practitioners, and other clinicians are often indicated.. Further research is needed to develop more targeted radiation therapy treatments, prophylaxis to prevent or minimize RIP, and ultimately treatments that effectively reverse RIP.