Effective treatment of the brachial plexus syndrome in breast cancer patients by early detection and control of loco-regional metastases with radiation or systemic therapy.
BACKGROUND
In breast cancer (BC) patients the brachial plexus syndrome (BPS) has been reported to be due to loco-regional metastases or radiation plexopathy. Associated arm edema is considered more suggestive of the latter. Radiation therapy is the only effective treatment for BPS reported.


METHODS
The charts of all BC patients who presented to our clinic from 1982 to 2006 with homolateral arm pain and neurological deficits, without humerus, cervical spine, or brain metastases, were reviewed.


RESULTS
There were 28 patients fulfilling these criteria for BPS. Supraclavicular, axillary or chest wall metastases developed synchronously with the BPS in 26 patients; in 21 they were recurrences, found 6-94 months (median 34 months) after primary BC treatment, while in 5 others they were progressing inoperable primary tumors and nodes. Arm edema first occurred at the same time as loco-regional metastases in 19 patients. Treatment for the BPS was administered to 22 patients; it was directed at their locoregional metastases. The BPS was initially treated with radiation (8 patients) or chemo- or endocrine therapy (14 patients); 19 (86%) had partial or complete remission of pain and neurologic deficits, with an 8-month median duration.


CONCLUSIONS
The BPS in BC patients is due to loco-regional metastases and is often associated with arm edema. Chemo- or endocrine therapy induced the remission of pain and deficits as frequently as radiation therapy.
Kamenova
Boriana
B
Department of Medicine, Downstate Medical College, State University of New York, Brooklyn, New York 11203-2098, USA.
Braverman
Albert S
AS
Schwartz
Michael
M
Sohn
Chul
C
Lange
Christopher
C
Efiom-Ekaha
Daniel
D
Rotman
Marvin
M
Yoon
Harold
H
D000328:Adult; D000368:Aged; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000628:therapy*; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D013577:Syndrome