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Topic: radiation-induced brachial plexopathy

Forum: Lymphedema — Risks, tips for prevention, and info about products that can address the symptoms of lymphedema.

Posted on: Jan 9, 2008 08:33PM, edited Aug 30, 2009 11:55AM by Erica35

Erica35 wrote:

Looks like I'm special as I'm one of the <2% of patients who get this complication. Really tired of being special...

I don't want to scare anyone off of radiation....it's an important part of breast cancer treatment. There are risk factors for my complication such as supraclavicular and axillary radiation, high rads dose, young age, and concurrent chemo. If you have had paresthesias (burning, tingling, etc), numbness, swelling, or weakness in your radiated side could you respond to this? Since it is so rare, there is not much literature for me to go on about my prognosis. Looking for someone else with experience. I think it might be related to my having avastin after radiation.

Any of you other gals in the avastin treatment after radiation have any problems with arm pain, hand paresthesias, hand or arm weakness?

I'm really struggling through this freaking marathon, after having surgery, 4 months dd chemo, more surgery, radiation, 5 months avastin/xeloda continously since July 2006 I am now facing multiple complications. First I had a lung injury from the interaction of avastin with radiation which left me breathless and unable to exercise for a few months (started beginning of October, now resolved). Then I had this arm problem which started the end of October with burning in my hand and has now progressed so that I can't button things or open jars or cans or do anything that requires fine motor skills. Also my fingers are numb along with the constant burning and I have arm pain that feels like a vice. Apparently, there is no treatment for radiation-induced brachial plexopathy so this is a new disability that I will have to deal with for the rest of my life. Searching for the energy to meet this new challenge....

Best, Erica

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Posts 571 - 583 (583 total)

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Jan 30, 2014 01:41AM bhd1 wrote:

am i correct in assuming that ribp cannot be helped by physical therapy.?

barb

Dx 9/22/2011, IDC, 3cm, Stage IV, Grade 3, ER-/PR-, HER2+
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Jan 30, 2014 07:49AM Binney4 wrote:

barb, a knowledgeable therapist can be a great help in helping to maintain strength and range of motion for as long as possible. A good LE therapist also needs to be involved, as a dependent or painful arm needs extra help to keep the fluid moving. And an occupational therapist can help with adjustment to specific activities of daily living when one arm is disabled.

The real trick is getting your insurance to see it that way, since they want to see progress toward a "cure" in order to continue to fund it. So that part might take some appeals in order to get what you need. 

Hugs!
Binney

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Feb 2, 2014 12:23PM Dorian wrote:

Barb, Yes, chemotherapy can cause shoulder pain. I am currently receiving chemotherapy for a BC recurrence and was recently diagnosed with brachial plexopathy. They think it is the result of inflammation caused by my chemo drugs (Gemzar/carboplatin) rather than the radiation I had in 2001 because I only have pain for a couple of days after I have chemo. My radiation oncologist says that if the BP was caused by radiation, the pain probably would be continuous rather than sporadic. We'll see what happens when the chemo ends.

Christine

Dx 10/2000, ILC, 2cm, Stage IIIa, 6/16 nodes, ER+/PR+, HER2+Dx 9/2013, 3cm, ER-/PR-, HER2-Surgery 11/17/2000 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Right)Chemotherapy 01/04/2001 Adriamycin, Cytoxan, TaxolRadiation Therapy 08/01/2001 ExternalHormonal Therapy 10/01/2001 TamoxifenChemotherapy 09/24/2013 carboplatin, Gemzar
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Mar 3, 2014 12:32PM lionessdoe wrote:

Feedback wanted on this!

          Radiation-Induced Brachial Plexopathy

Radiation therapy to the chest, neck or axillary region for the underlying tumor may result in brachial plexopathy. Factors like radiation dose, technique and concomitant chemotherapy play a vital role in the brachial plexus injury.[44] Radiation dose < 6000 cGy less likely leads to plexopathy. The interval from the last dose of radiation to the first symptom of plexus disorder is usually a mean of 6 years. Breast carcinoma is most commonly associated with radiation plexopathy (40-75%), which is followed by lung carcinoma and lymphoma.[45]

Limb paresthesia, swelling, and motor weakness are common presenting complaints. Pain is not a consistent feature of such plexopathies. Unlike metastatic injury, radiation-induced plexopathy has a predilection for the upper trunk and not for the lower trunk, probably secondary to the protective effect of the clavicle and relatively shorter course of the lower trunk through the radiation port. Endoneural and perineural fibrosis, occlusion of microvasculature and direct injury to the myelin sheaths and axons are the proposed mechanisms for radiation-induced plexopathy. MRI may show thickening and diffuse enlargement of the brachial plexus without the focal mass, but does not always differentiate metastatic and radiation injuries.[46] Radiation fibrosis in the chronic form appears as hypointense on T1WI and T2WI.[47] Nerve conduction studies in the early stages may show features of demyelinating conduction blocks. Unlike metastatic plexopathy, EMG studies in radiation injury show spontaneous activity in the form of myokymic discharges.[48]

It has dismal prognosis, with the patient requiring palliative care depending on the distressing symptoms. Lymphatic bypass surgery to relieve lymphedema may rarely be required. The patient is advised to continue rehabilitative measures.


Doe

Dx 9/5/2007, IDC, 1cm, Stage IIIa, Grade 2, 4/19 nodes, ER+/PR+, HER2-
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Mar 3, 2014 04:18PM Binney4 wrote:

Hi, Doe!

This was published about a year ago in the Annals of Indian Academy Neurology, from Mumbai in India. I didn't think there was much new in it. What in particular were you looking for feedback on?

Hope you're doing well!
Binney

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Mar 3, 2014 05:08PM lionessdoe wrote:

Hi Binney! Hanging in there.  I question the 6 year average for onset. Thanks!

Doe

Dx 9/5/2007, IDC, 1cm, Stage IIIa, Grade 2, 4/19 nodes, ER+/PR+, HER2-
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Mar 15, 2014 03:19AM, edited Mar 15, 2014 03:27AM by LindaKR

Hmmm, 6 years doesn't seem right, I thought I read elsewhere 6 months, not sure though!

Modified Radical MX w/axillary dissection; 6xTCH, Hercpetin for a year, Rads, trying 3rd AI Aromasin. No Reconstruction. Lymphedema.

Dx 3/19/2010, IDC, 4cm, Stage IIIa, Grade 2, 5/18 nodes, ER+/PR+, HER2+Surgery 04/02/2010 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left)Chemotherapy 05/15/2010 carboplatin, TaxotereTargeted Therapy 05/15/2010 HerceptinHormonal Therapy 09/15/2010 AromasinRadiation Therapy 09/25/2010 External
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Mar 15, 2014 08:55AM, edited Mar 16, 2014 03:07PM by Infobabe

Six years sounds right to me.  Radiation damage shows up much later from the posts I have been reading.

Dx 3/15/2012, DCIS, <1cm, Stage 0, Grade 1, ER+/PR+Surgery 05/01/2012 Lumpectomy (Left)
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Mar 15, 2014 09:55AM Binney4 wrote:

I agree--six years isn't off the radar for this to appear. Which doesn't mean it can't show up sooner, but my sense is that it more often takes some time to appear. Nasty surprise after all that time too.
Hugs,
Binney

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Apr 8, 2014 03:12PM Binney4 wrote:

bump

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Apr 11, 2014 03:24PM barbaraellen wrote:

Hi Ladies,

I have been absent a long time, but now I am back, and catching up on the latest posts.  I can throw my 2 cents

in here about the cause of BP.  I never had chemo, just radiation, and 20  years later the first symptoms of

BP showed up.   I have always heard that it is caused by radiation.  I am heartened to know that the percentage

of patients who develope BP is not 2% or 4%, as I always read, but increases greatly to amost half of all patients at 20 years or more!  I feel less freaky and not nearly as isolated as I did for years.  

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Apr 11, 2014 04:24PM hugz4u wrote:

Barb. thanks for popping in. I have been lurking on this thread for awhile and find it so interesting...not that interested in myself contracting this condition though... but one must get educated on stuff like this as MD's just not that smart with aftereffects of BC.

How have you been doing and are the symptoms stable or getting worse? Dang postcancer stuff.

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Apr 11, 2014 05:17PM Binney4 wrote:

BarbaraEllen, so good to hear from you! 20 years later is truly a nasty "surprise," but it sure does explain how an "average" of six years could be arrived at. Would love to hear how you're doing. Still traveling?

Here's my latest more-questions-than-answers article on new hope for paralysis caused by lost nerve connections:

http://www.bbc.com/news/health-26920521

This is not about RIBP, but about spinal injuries. May be totally unrelated, but I'm working on tracking down the study author, and I'll let you know if she answers.

Big hugs!
Binney

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