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A patient questionnaire for radiation-induced brachial plexopathy
Ulrike Hoeller1, Karin Rolofs, Amira Bajrovic
1Department of Radiotherapy and Radiooncology, University Hospital Eppendorf, Hamburg, Germany. hoeller@knk-berlin.de
American Journal of Clinical Oncology
|February 6, 2004
Summary
A questionnaire effectively screens for radiation-induced brachial plexopathy (RIBP) after breast cancer treatment. The questions "impaired hand functions" and "problems raising the arm" are key indicators for identifying patients at risk of RIBP.
Area of Science:
- Oncology
- Neurology
- Radiotherapy
Background:
- Breast cancer treatment often involves radiotherapy, which can lead to radiation-induced brachial plexopathy (RIBP).
- Accurate screening for RIBP is crucial for timely intervention and management.
- Existing screening methods may not fully capture the nuances of RIBP symptoms.
Purpose of the Study:
- To evaluate the diagnostic usefulness of a specific symptom questionnaire for screening radiation-induced brachial plexopathy (RIBP) in breast cancer patients.
- To identify key questions within the questionnaire that are most effective in detecting RIBP.
- To determine the relationship between RIBP, fibrosis, and arm edema post-treatment.
Main Methods:
- A cohort of 81 relapse-free breast cancer patients who received radiotherapy (mastectomy or breast-conserving surgery with supraclavicular +/- axilla radiation) were neurologically examined.
- A control group of 65 patients who had breast-conserving surgery and breast-only radiotherapy were also assessed.
- A four-question symptom questionnaire addressing paresis (impaired hand function, problems raising arm, carrying weights, lifting from shelf) was administered and analyzed for sensitivity and specificity in detecting RIBP.
Main Results:
- Sixteen patients were diagnosed with RIBP, with varying RTOG grades.
- The question "impaired hand functions" showed a sensitivity of 0.80 and specificity of 0.66 for RIBP.
- The question "problems raising the arm" demonstrated high specificity (0.98) for detecting severe RIBP, with only 3% false positives in controls.
- Multivariate analysis identified "impaired hand functions" and fibrosis as independent predictors of RIBP.
- RIBP can occur without significant fibrosis, and some symptoms were reported by patients who did not receive supraclavicular radiation.
Conclusions:
- The developed questionnaire is a valuable tool for screening radiation-induced brachial plexopathy (RIBP) in breast cancer survivors.
- "Impaired hand functions" is a sensitive indicator, while "problems raising the arm" is a highly specific indicator for severe RIBP.
- The combination of these two questions in follow-up assessments can effectively identify patients requiring further evaluation for RIBP, irrespective of fibrosis presence.