Brachial plexus lesions in patients with cancer: 100 cases

In patients with cancer, brachial plexus signs are usually caused by tumor infiltration or injury from radiation therapy (RT). We analyzed 100 cases of brachial plexopathy to determine which clinical criteria helped differentiate tumor from radiation injury. Seventy-eight patients had tumor (34 with previous RT), and 22 had radiation injury. Severe pain occurred in 80% of tumor patients but in only 19% of patients with radiation injury. The lower trunk (C7-8, T1) was involved in 72% of the tumors, and 32% also had epidural tumors. Seventy-eight percent of the radiation injuries affected the upper plexus (C5-6). Horner syndrome was more common in tumor, and lymphedema in radiation injury. The time from RT to onset of plexus symptoms, and the dose of RT, also differed. For symptoms within 1 year of RT, doses exceeding 6000 R were associated with radiation damage, whereas lower doses were associated with infiltration. Therefore, painless upper trunk lesions with lymphedema suggest radiation injury, and painful lower trunk lesions with Horner syndrome imply tumor infiltration.