Diagnosis and treatment of lumbosacral plexopathies in patients with cancer.
ABSTRACT Eleven patients were diagnosed as having lumbosacral plexopathy at M. D. Anderson Hospital, Houston, from August 1981 through July 1982. Four causes were documented: plexopathy secondary to metastatic disease (six cases); radiation-induced plexopathy (two cases); plexopathy secondary to intra-arterial chemotherapy (two cases); and plexopathy as the result of a second primary tumor (one case). Patients with plexopathies secondary to tumor or irradiation complained of pain in the ipsilateral lower extremity. Computed tomography of the pelvis was the most accurate method of documenting tumor in the region of the lumbosacral plexus. Radiation therapy records of patients with cervical carcinoma were reviewed with respect to positioning of intracavitary radium, which was thought to be responsible for the development of radiation-induced plexopathies. Radiation therapy and/or systemic chemotherapy provided relief of pain and improvement of neurologic deficits in three patients with metastatic involvement.
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ABSTRACT: To evaluate the dose distribution to the lumbosacral plexus (LSP) and its correlation with radiation-induced lumbosacral plexopathy (RILSP) in patients with cervical cancer treated with intensity-modulated radiotherapy (IMRT) and high-dose-rate brachytherapy. After meeting eligibility criteria, 50 patients with cervical cancer were selected who were treated with IMRT and high-dose-rate brachytherapy, and the LSP was contoured. Mean volume; percentages of LSP volume absorbing 40, 50, 55, and 60 Gy (V30, V40, V50, V55, and V60) and point doses (P1, P2, P3, P4, P5, P6, P7, P8, P9, and P10); and RILSP incidence were calculated. At 60 months of follow-up, four patients (8%) were found to have grade 2/3 RILSP. The mean maximal LSP dose in patients with RILSP was 59.6 Gy compared with 53.9 Gy in patients without RILSP (control; P=0.04). The mean values of V40, V50, V55, and V60 in patients with RILSP versus control were 61.8% versus 52.8%, 44.4% versus 27.7%, 8.0% versus 0.3% and 1.8% versus 0%, respectively (P=0.01, 0.001, 0.001, and 0.001, respectively). The delineation of the LSP during IMRT planning may reduce the risk for RILSP. The mean values of V40, V50, V55, and V60 for LSP should be less than 55%, 30%, 5%, and 0.5%, respectively; however, further studies are warranted.OncoTargets and Therapy 01/2015; 8:21-7. DOI:10.2147/OTT.S71086 · 1.34 Impact Factor
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ABSTRACT: Neoplastic lumbosacral plexopathy is one of the most disabling complications in subjects with cancer. Its clinical presentation is characterized by pain, muscle weakness and sensory complaints in one or both limbs.There are only a few cases in the neurosurgical literature as it is mostly treated by pain therapy, radiotherapy and/or chemotherapy. However, surgical exploration may be necessary in some patients without a definitive diagnosis, or those who do not respond to medical therapy, even with narcotics. A 50-year-old female with lumbosacral plexopathy 3 years after treatment of cervical carcinoma is reported. Her severe leg pain did not resolve even by narcotics, and there were weaknesses of knee flexion and foot dorsi- and plantar flexions. Her radiological examinations revealed a mass looking like an abscess at the entrance of the true pelvis, and her infection markers were high. Surgical exploration was performed because of suspicion of intrapelvic abscess. However, a metastatic lymph node compressing the plexus was found. Her pain clearly diminished after operation, and she did not require narcotics but the weakness was unchanged. She was treated by chemotherapy after the surgery and her pain was mild after three months.Turkish neurosurgery 01/2006; 16:204-207. · 0.53 Impact Factor
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ABSTRACT: Several groups have reported cases of rectal cancer with carcinomatous involvement of the lumbosacral plexus and sciatic, obturator, pudendal, or spinal nerves. To our best knowledge, clear examples of perineural tumor spread in rectal carcinoma have not yet been described. We retrospectively reviewed clinical data and imaging studies of three patients with primary or recurrent rectal cancer involving the lumbosacral plexus. Imaging studies included MRI and 18FDG PET/CT scans in all (n = 3) patients, histological samples were available in two (n = 2). Imaging studies demonstrated distinct features of tumor spread from the organ to the plexus and beyond in all cases (n = 3), histological specimens demonstrated perineural involvement thus supporting our theory (n = 2). We present these three cases of perineural tumor spread in rectal cancer as a proof of concept. We hypothesize that not only our cases, but other similar reported cases can be explained anatomically by extension of the rectal cancer to the inferior hypogastric plexus with perineural tumor spread to the lumbosacral plexus using the pelvic and sacral splanchnic nerves as conduits. Once the tumor reaches the lumbosacral plexus, it can continue to spread proximally or distally. We believe that perineural spread of colon cancer represents an important, under-recognized mechanism of recurrence to neighboring major nerves in the pelvis. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.Clinical Anatomy 08/2014; 28(1). DOI:10.1002/ca.22450 · 1.16 Impact Factor