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

Authors: Jacek Galecki a;  Joanna Hicer-Grzenkowicz a;  Malstrokgorzata Grudzien-Kowalska a;  Teresa Michalska b; Wojciech Zalucki a
Affiliations:   a Department of Radiotherapy, Maria Sklstrokodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
b Second Department, Academy of Medicine, Neurological Clinic, Warsaw, Poland
DOI: 10.1080/02841860500371907
Publication Frequency: 8 issues per year
Published in: journal Acta Oncologica, Volume 45, Issue 3 April 2006 , pages 280 - 284
Subject: Oncology;
Formats available: HTML (English) : PDF (English)
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Abstract

In order to increase the availability of adjuvant radiotherapy of breast cancer patients and make it more convenient and cheaper, in numerous cancer centres, the dose per fraction has been increased from 2 Gy to 2.25-2.75 Gy and the total dose has been decreased from 50 Gy to 40-45 Gy. The risk of developing any late complications after conventionally fractionated megavoltage radiotherapy is estimated to be below 1%. The aim of this review is to determine whether hypofractionated regimens increase the risk of damage to the brachial plexus. A review of the published literature shows that the use of doses per fraction in the range from 2.2 Gy to 4.58 Gy with the total doses between 43.5 Gy and 60 Gy causes a significant risk of brachial plexus injury which ranged from 1.7% up to 73%. The risk of radiation induced brachial plexopathy was smaller than 1% using regimens with doses per fraction between 2.2 and 2.5 Gy with the total doses between 34 and 40 Gy. Surgical manipulations in the axilla and chemotherapy have to be taken into account as additional factors which may increase the risk of brachial plexopathy.
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