title: Progressive muscle atrophy and weakness after treatment by mantle field radiotherapy in Hodgkin lymphoma survivors.
abstract: OBJECTIVE
  To describe the damage to the muscles and propose a pathophysiologic mechanism for muscle atrophy and weakness after mantle field radiotherapy in Hodgkin lymphoma (HL) survivors.
  
  
  METHODS
  We examined 12 patients treated by mantle field radiotherapy between 1969 and 1998. Besides evaluation of their symptoms, the following tests were performed: dynamometry; ultrasound of the sternocleidomastoid, biceps, and antebrachial flexor muscles; and needle electromyography of the neck, deltoid, and ultrasonographically affected arm muscles.
  
  
  RESULTS
  Ten patients (83%) experienced neck complaints, mostly pain and muscle weakness. On clinical examination, neck flexors were more often affected than neck extensors. On ultrasound, the sternocleidomastoid was severely atrophic in 8 patients, but abnormal echo intensity was seen in only 3 patients. Electromyography of the neck muscles showed mostly myogenic changes, whereas the deltoid, biceps, and antebrachial flexor muscles seemed to have mostly neurogenic damage.
  
  
  CONCLUSIONS
  Many patients previously treated by mantle field radiotherapy develop severe atrophy and weakness of the neck muscles. Neck muscles within the radiation field show mostly myogenic damage, and muscles outside the mantle field show mostly neurogenic damage. The discrepancy between echo intensity and atrophy suggests that muscle damage is most likely caused by an extrinsic factor such as progressive microvascular fibrosis. This is also presumed to cause damage to nerves within the radiated field, resulting in neurogenic damage of the deltoid and arm muscles.
authors.affiliation: Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. e.segarceanu@antoniusziekenhuis.nl
authors.forename: Elena M
authors.initials: EM
authors.lastname: van Leeuwen-Segarceanu
authors.forename: Lucille D A
authors.initials: LD
authors.lastname: Dorresteijn
authors.forename: Sigrid
authors.initials: S
authors.lastname: Pillen
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
authors.forename: Oscar J M
authors.initials: OJ
authors.lastname: Vogels
authors.forename: Nens
authors.initials: N
authors.lastname: van Alfen
mesh_terms: D000328:Adult; D018450:Disease Progression; D004576:Electromyography / Q000379:methods; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000528:radiation effects*; D009133:Muscular Atrophy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D009334:Neck Muscles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000528:radiation effects; D009431:Neural Conduction / Q000502:physiology; D010146:Pain / Q000209:etiology; D017741:Survivors; D014463:Ultrasonography