title: Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients?
abstract: OBJECTIVE
  To contribute to the question whether the risk of radiation-related brachial plexopathy increases, remains constant or decreases with time after treatment.
  
  
  METHODS
  Between 12/80 and 9/93, 140 breast cancer patients received supraclavicular lymph node irradiation using a telecobalt unit. Total dose was 60 with 3Gy per fraction at a depth of 0.5 cm and 52 with 2.6Gy per fraction to the brachial plexus at a depth of 3 cm. Twenty-eight women received chemotherapy, 34 tamoxifen. Brachial plexopathy was graded using a modified LENT-SOMA score. Actuarial complication-free survival and overall survival were obtained from Kaplan-Meier analysis. The impact of chemotherapy or tamoxifen was tested using the chi2 test. The annual incidence of radiation-related brachial plexopathy was assessed by exponential regression as described by Jung et al. [Radiother Oncol 61 (2001) 233].
  
  
  RESULTS
  Actuarial overall survival was 67.1% after 5 years, 54.0% after 10 years, 49.9% after 15 years, and 44.0% after 20 years. In 19/140 patients, brachial plexopathy grade>/=1 occurred after a median interval of 88 (30-217) months. The percentage of patients being free from plexopathy was 96.1% after 5 years, 75.5% after 10 years, 72.1% after 15 years, and 46.0% after 19 years, respectively. A significant impact of type of surgery, chemotherapy or tamoxifen was not observed. The annual incidence of brachial plexopathy was 2.9% for grade>/=1 lesions and 0.8% for grade>/=3 lesions. The rates did not change significantly with time.
  
  
  CONCLUSIONS
  The risk of brachial plexopathy after supraclavicular lymph node irradiation in breast cancer patients remains constant for a considerable portion of the patient's life.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Fabian
authors.initials: F
authors.lastname: Fehlauer
authors.forename: Silke
authors.initials: S
authors.lastname: Tribius
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hoeller
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Horst
authors.initials: H
authors.lastname: Jung
authors.forename: Winfried
authors.initials: W
authors.lastname: Alberti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000209:etiology*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects*; D008875:Middle Aged; D013997:Time Factors