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Published online: 2024-06-19

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Radiation induced brachial plexopathy in head and neck cancer patients treated with definitive radiotherapy and correlation with disease characteristics and dosimetric parameters

Hadrian Noel Alexander F1, Nirmala Srikantia1, Sandeep Muzumder1, Avinash H Udayashankara1, John Sebastian MG1, Deepu C Tom1, R.P. Kathiressan1, John Michael Raj2

Abstract

Background: Definitive concurrent chemoradiotherapy (CRT) is the standard of care in advanced stages of head and neck cancer (HNC). With evident increase in survival rate there is also simultaneous increase in toxicity affecting the quality of life. One of the less researched late toxicity is radiation induced brachial plexopathy (RIBP). In this dosimetric study we intent to contour the brachial plexus (BP) as an organ at risk (OAR) and determine the factors that contribute to dose variations to BP, and clinically evaluate the patients for RIBP during follow-up using a questionnaire.

Materials and methods: 30 patients with HNC planned for CRT from September 2020 to June 2022 were accrued. Patients were treated to a dose of 6600 cGy with intensity modulated radiotherapy using the simultaneous integrated boost technique. From dose-volume histogram (DVH) statistics the BPvolume, Dmax and other parameters like V66, V60 were assessed and was correlated with respect to primary tumour and nodal stage.

Results: On corelation more than T stage, N stage and primary tumour location had a significant impact on Dmax. With a median follow-up of 17.9 months, the incidence of RIBP is 6.67%. The 2-year disease free survival and 2-year Overall Survival are 53.7% and 59.4%, respectively.

Conclusions: In oropharyngeal/hypopharyngeal primaries and in advanced nodal disease, BP receives higher doses contributing to RIBP. Primary tumor and nodal stage also impacted V60 and V66 of BP. Hence, contouring of BP as an OAR becomes imperative, and respecting the DVH parameters is essential.

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