Brachial Plexopathy After Postoperative Radiotherapy of Breast Cancer Patients

Acta Oncologica Vol. 39, No. 3, pp. 373–382, 2000In 1963–1965 a group of 71 patients operated on for breast cancer with total mastectomy and axillary clearance were given aggressivepostoperative telecobalt therapy to the axillary, supraclavicular and parasternal lymph node regions. The prescribed dose to these lymphnode regions was 44 Gy in 11 fractions. Only two of the three fields were treated per day. Retrospective dose calculations showed thatthe total dose in the brachial plexus from the axillary and supraclavicular fields was c. 57 Gy in 16–17 fractions over 3–4 weeks. Aftera few years, symptoms and signs of brachial plexus injury appeared in many patients, which was reported in some early papers. Thecohort has now been followed-up to 34 years. As expected, there was progression of both prevalence and severity of the late effectsbetween 5 and 34 years and 11 of 12 patients who are still alive have paralysis of their arms. The neuropathy seems to be closely linkedto fibrosis around the nerve trunks. The use of large daily fractions, in some cases combined with hot spots from overlapping fields, wascertainly the cause of the complication.