open access

Vol 25, No 1 (2020)
Published online: 2020-01-01
Submitted: 2019-04-29
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Hyperbaric oxygen therapy for radiation-induced brachial plexopathy, a case report and literature review

Hayley B. Stowe, Brandon T. Mullins, Bhishamjit S. Chera
DOI: 10.1016/j.rpor.2019.10.010
·
Rep Pract Oncol Radiother 2020;25(1):23-27.

open access

Vol 25, No 1 (2020)
Published online: 2020-01-01
Submitted: 2019-04-29

Abstract

Aim

To report a case of radiation-induced brachial plexopathy (RIBP) with significant radiographic and clinical improvement after a course of hyperbaric oxygen (HBO).

Background

RIBP is a rare complication after radiotherapy to the neck and axilla. There are no standard treatment options, with empirical use pharmacotherapy being predominately used, which has had mixed results.

HBO is efficacious for the treatment of other severe radiation-induced side effects, however, its benefit in RIBP has conflicting reports.

Case Presentation

A 45-year-old male, with a 33 pack-year smoking history, presented with a 6-month history of a progressive left neck mass. The final diagnosis was unknown primary squamous cell carcinoma of the head and neck. He received intensity-modulated radiation therapy (IMRT) with 70Gy prescribed to the gross tumor volume (PTV HR) and 56Gy to the oropharynx, nasopharynx, and bilateral lymphatics (PTV SR) in 35 daily fractions with three cycles of concurrent cisplatin at 100mg/m2.

Fifteen months following therapy completion, the patient began to endorse symptoms of left brachial plexopathy. Decadron was prescribed for 2 weeks, trental and vitamin E for 6 months, and HBO. The patient returned for follow-up 2 months after completing 30 dives of HBO at 2.4atmospheres for 2hours per session. He reported pain resolution and full range of motion of his left arm.

Conclusions

The best management strategy of RIBP is prevention by reducing total RT doses and close follow-up. However, when RIBP occurs, we recommend treatment with HBO therapy, steroids, trental, and vitamin E as tolerable.

Abstract

Aim

To report a case of radiation-induced brachial plexopathy (RIBP) with significant radiographic and clinical improvement after a course of hyperbaric oxygen (HBO).

Background

RIBP is a rare complication after radiotherapy to the neck and axilla. There are no standard treatment options, with empirical use pharmacotherapy being predominately used, which has had mixed results.

HBO is efficacious for the treatment of other severe radiation-induced side effects, however, its benefit in RIBP has conflicting reports.

Case Presentation

A 45-year-old male, with a 33 pack-year smoking history, presented with a 6-month history of a progressive left neck mass. The final diagnosis was unknown primary squamous cell carcinoma of the head and neck. He received intensity-modulated radiation therapy (IMRT) with 70Gy prescribed to the gross tumor volume (PTV HR) and 56Gy to the oropharynx, nasopharynx, and bilateral lymphatics (PTV SR) in 35 daily fractions with three cycles of concurrent cisplatin at 100mg/m2.

Fifteen months following therapy completion, the patient began to endorse symptoms of left brachial plexopathy. Decadron was prescribed for 2 weeks, trental and vitamin E for 6 months, and HBO. The patient returned for follow-up 2 months after completing 30 dives of HBO at 2.4atmospheres for 2hours per session. He reported pain resolution and full range of motion of his left arm.

Conclusions

The best management strategy of RIBP is prevention by reducing total RT doses and close follow-up. However, when RIBP occurs, we recommend treatment with HBO therapy, steroids, trental, and vitamin E as tolerable.

Get Citation

Keywords

Radiation-induced brachial plexopathy; Hyperbaric oxygen therapy; Head and neck; Intensity-modulated radiation therapy

About this article
Title

Hyperbaric oxygen therapy for radiation-induced brachial plexopathy, a case report and literature review

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 1 (2020)

Pages

23-27

Published online

2020-01-01

DOI

10.1016/j.rpor.2019.10.010

Bibliographic record

Rep Pract Oncol Radiother 2020;25(1):23-27.

Keywords

Radiation-induced brachial plexopathy
Hyperbaric oxygen therapy
Head and neck
Intensity-modulated radiation therapy

Authors

Hayley B. Stowe
Brandon T. Mullins
Bhishamjit S. Chera

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