Diagnosis and Treatment of Lumbosacral Plexopathies in Patients With Cancer

JAMA Neurology (Impact Factor: 7.42). 01/1985; 41(12):1282-5. DOI: 10.1001/archneur.1984.04050230068022
Source: PubMed


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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    • "Several other cases of the sciatic nerve (Rao et al., 1982; Gaeta et al., 1988; Kameyama et al., 1993; Beets-Tan et al., 2000; Sinaei et al., 2013) as well as obturator (Gaeta et al., 1988; Tan et al., 2011; Sinaei et al., 2013), pudendal (Gaeta et al., 1988), inferior gluteal, and posterior femoral cutaneous nerve involvement (LaBan et al., 1982) have been reported, which we believe, can also be explained anatomically: either as spread from the infiltrated lumbosacral plexus, as in our cases, or by direct tumorous invasion during their intrapelvic course with subsequent perineural spread. Neoplastic LSP typically presents with pain followed by weakness and numbness within weeks (Pettigrew et al., 1984; Jaeckle, 2010). Pain can be various in nature, from local, centered to radiculopathic (Seefeld and Bargen, 1943; Jaeckle et al., 1985; Ladha et al., 2006; Grisold et al., 2013) and is present in up to 98% of LSPs, which led some authors to conclude that the absence of pain should question the presence of plexopathy (Jaeckle et al., 1985). "
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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.
    Full-text · Article · Aug 2014 · Clinical Anatomy
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    • "Radiotherapy is often used, but in the setting of a previously irradiated field it is used with caution. Pain relief with radiotherapy is achieved in approximately 50% of patients[8,15,34,35]. Reversal of the neurologic deficit is realized in only one-third. "
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    ABSTRACT: The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge.
    Full-text · Article · Dec 2013 · Cancer Imaging
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    • "Elles ont e ´ té e ´ galement rapporté es aprè s une radiothé rapie a ` forte dose (plus de 60 Gy) pour des cancers pelviens (Chen, 2011). Par ailleurs, des cas de radiculopathies ont e ´ té dé crits aprè s une irradiation intra-uté rine par radium (Pettigrew et al., 1984). Enfin, aprè s une irradiation a ` forte dose pour des sarcomes ré tropé ritoné aux paraspinaux, une atteinte neurologique pé riphé rique e ´ tait observé e dans 25 % des cas aprè s une duré e mé diane de sept ans (Pieters et al., 2006). "
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    ABSTRACT: IntroductionBecause of the improvement of cancer prognosis, long-term damages of treatments become a medical and public health problem. Among the iatrogenic complications, neurological impairment is crucial to consider since motor disability and pain have a considerable impact on quality of life of long cancer survivors. However, radiation-induced neuropathies have not been the focus of great attention. The objective of this paper is to provide an updated review about the radiation-induced lesions of the peripheral nerve system.State of the artRadiation-induced neuropathies are characterized by their heterogeneity in both symptoms and disease course. Signs and symptoms depend on the affected structures of the peripheral nerve system (nerve roots, nerve plexus or nerve trunks). Early-onset complications are often transient and late complications are usually progressive and associated with a poor prognosis. The most frequent and well known is delayed radiation-induced brachial plexopathy, which may follow breast cancer irradiation. Radiation-induced lumbosacral radiculoplexopathy is characterized by pure or predominant lower motor neuron signs. They can be misdiagnosed, confused with amyotrophic lateral sclerosis (ALS) or with leptomeningeal metastases since nodular MRI enhancement of the nerve roots of the cauda equina and increased cerebrospinal fluid protein content can be observed. In the absence of specific markers of the link with radiotherapy, the diagnosis of post-radiation neuropathy may be difficult. Recently, a posteriori conformal radiotherapy with 3D dosimetric reconstitution has been developed to link a precise anatomical site to unexpected excess irradiation.Perspectives and conclusionThe importance of early diagnosis of radiation-induced neuropathies is underscored by the emergence of new disease-modifying treatments. Although the pathophysiology is not fully understood, it is already possible to target radiation-induced fibrosis but also associated factors such as ischemia, oxidative stress and inflammation. A phase III trial evaluating the association of pentoxifylline, tocopherol and clodronate (PENTOCLO, NCT01291433) in radiation-induced neuropathies is now recruiting.
    Full-text · Article · Dec 2012 · Revue Neurologique
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