Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options

Abstract

Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.