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Brachial Plexus Tolerance to Single-Session SABR in a Pig Model
Brian Hrycushko1, Albert J van der Kogel2, Lauren Phillips3
1Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas.
International Journal of Radiation Oncology, Biology, Physics
|October 1, 2021
Summary
This study found that the brachial plexus in pigs has a similar radiation tolerance to the spinal cord, with an estimated 50% effective dose (ED50) of 19.3 Gy for neurological deficit. These findings challenge previous perceptions of peripheral nerve radiation tolerance.
Area of Science:
- Radiation Oncology
- Neurology
- Preclinical Research
Background:
- Peripheral nerves were previously thought to be more radiation tolerant than the spinal cord.
- Limited data exists on the single-session dose tolerance of the brachial plexus.
- Pigs serve as a relevant animal model for studying spinal nerve and cord radiation tolerance.
Purpose of the Study:
- To determine the single-session dose-response of the brachial plexus in a preclinical model.
- To establish the estimated dose for 50% of pigs developing neurological deficit (ED50) after brachial plexus irradiation.
- To compare brachial plexus radiation tolerance with that of the spinal cord and spinal nerves in pigs.
Main Methods:
- Ten Yucatan minipigs underwent stereotactic radiotherapy targeting a 2.5-cm segment of the brachial plexus.
- Pigs received single-session doses of 16, 19, or 22 Gy.
- Neurological status was assessed via gait observation and electrodiagnostic tests; histopathology confirmed radiation-induced neuropathy.
Main Results:
- Seven out of ten pigs developed motor deficits in the irradiated limb within 5-8 weeks.
- The estimated single-session ED50 for symptomatic plexopathy was 19.3 Gy.
- Histopathology confirmed radiation-induced neuropathy in symptomatic pigs, with nerve conduction studies showing impaired sensory and motor responses.
Conclusions:
- The single-session dose tolerance of the brachial plexus in pigs is comparable to the spinal cord and nerves.
- The ED50 for symptomatic plexopathy was determined to be 19.3 Gy in this pig model.
- Extrapolation of these findings to human clinical practice requires caution due to unknown interspecies differences.
