title: Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume.
abstract: OBJECTIVE
  To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer.
  
  
  METHODS
  The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand.
  
  
  RESULTS
  After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V40 Gy ≥ 13.5 cm(3), compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant).
  
  
  CONCLUSIONS
  Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden. Electronic address: dan.lundstedt@gu.se.
authors.forename: Dan
authors.initials: D
authors.lastname: Lundstedt
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Gustafsson
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Agnetha
authors.initials: A
authors.lastname: Sundberg
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.affiliation: Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.affiliation: Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Karlsson
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006225:Hand / Q000294:innervation; D006801:Humans; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation; D008408:Mastectomy; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology*; D011832:Radiation Injuries / Q000150:complications*; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011795:Surveys and Questionnaires; D013997:Time Factors