International Journal of Research in Medical Sciences | February 2017 | Vol 5 | Issue 2 Page 469 International Journal of Research in Medical Sciences Kunheri B et al. Int J Res Med Sci. 2017 Feb;5(2):469-472 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Original Research Article Brachial plexopathy in breast cancer: is it radiation related? An analysis technique and dose volume parameters to brachial plexus in breast cancer radiotherapy Beena Kunheri 1 *, Anand Radhakrishnan 2 , Toyce Stephan 1 , Renil Mon 3 , Anjali Menon 1 INTRODUCTION Brachial plexus dysfunction is a rare but well-recognized disabling complication of cancer that are caused by trauma to the plexus during surgery or anesthesia, metastatic spread of tumor, radiation injury , or radiation- induced plexus tumors. 1-7 Tumour related brachial plexus symptoms are common with superior sulcus tumours and tumors producing large supraclavicular or axillary nodal metastasis. Breast cancer being the most common cancer among females, treatment or disease related paraesthesia is a frequent complaint among breast cancer patients. Radiation-induced brachial plexopathy (RIBP) is a delayed complication of radiation treatment for tumors involving the neck and chest area. Irradiation to the brachial plexus leads to progressive fibrosis, nerve entrapment, ischemic demyelination, and conduction block. Although the incidence of brachial plexopathy is ABSTRACT Background: Brachial plexus dysfunction is a rare but well-recognized complication of breast cancer surgery and radiotherapy. Most of the time it presents as paraesthesia of the arm. In an earlier publication Dan Lundstedt et al from Sweden, quantitatively assessed the radiation related brachial plexopathy (mainly paraesthesia) with the help of dose volume histograms and its co relation between patient reported paraesthesia. Paraesthesia was reported by 25% after radiation therapy to the supraclavicular fossa, with a V40 Gy 13.5 cm 3 and maximum dose to brachial plexus (Dmax) was not found to correlate with paraesthesia. In order to predict the risk brachial plexopathy in our patients we decided to analyze the dose volume parameters for brachial plexus in carcinoma breast patients treated at our institution with modern radiotherapy techniques. Methods: Twenty five consecutive patients who received post mastectomy radiation during the period September 2015 to January 2016 with a dose of 50Gy in 25 fractions were included for this analysis. Brachial plexus contoured using RTOG guidelines, and dose volume parameters for brachial plexus were documented from the existing treatment plans. Results: The maximum dose to the brachial plexus ranged from 5045cGy to 5679cGy with a mean value of 5312.8cGy. The mean dose received by the brachial plexus ranged from 3093cGy to 4714cGy and the mean value was 4137.28cGy. Volume receiving 40Gy, that is V40, ranged from 2.0078cc to 11.56cc with a mean value of 7.57cc. Conclusions: Maximum dose and V40 Gy values were well below the tolerance limit of plexus, and hence post mastectomy irradiation with modern techniques is unlikely to produce significant brachial plexus neuropathy. Keywords: Brachial plexus, Breast cancer, Paraesthesia, Radiotherapy 1 Department of Radiotherapy, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India 2 Department of Radiotherapy, Trivandrum Medical College, Trivandrum, Kerala, India 3 Department of Medical physics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India Received: 29 December 2016 Accepted: 17 January 2017 *Correspondence: Dr. Beena Kunheri, E-mail: beenakunheri@yahoo.co.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170134