RILP?

[Kentucky1]

Anybody familiar with this complication of radiation therapy? I've been fighting with my left leg for the past 4 months with increasing loss of function. It started as a nightime drawing of my left leg across my body and has now progressed to paralysis of the quad muscles and I am now having to use a wheelchair to get around. We first thought it was hip bursitis, with swelling in the quad muscle, loss of function, and inability to straighten the leg. I can no longer stand on the leg as it will not support my weight. MRI, CT, and bone scan show stable disease as far as the cancer goes. MRI shows increased uptake in the psoas and iliacus muscles and overall swelling of the quad, groin, and oddly swelling of both feet, which may be totally unrelated. I've had one round of IV Medrol 1gm x 3 days with a result of minor improvement of symptoms. I'm currently waiting to see a neurologist to confirm this diagnosis.

[Tall_Allen]

Did you have radiation to the spine?

[Kentucky1 in reply to Tall_Allen]

No, I've had 2 rounds of radiation , the first to the pelvic area and femur heads, 5x5 for pallation of pain. The second was just 2 doses but higher Gy. Not sure of total dose but don't think it exceeded what you would see in standard EBRT therapy. The doses were about a year apart with these symptoms starting about 4 months after the second round. I've also been told that I have mild to moderate lumbar stenosis at L5-S1 that complicates the picture. I'm hoping for the neuro consult to clarify which one ,if either, to move forward. MS neuro says in her opinion it's not MS related.

[Graham49]

Evaluation and Management of Radiation-Induced Plexopathies

Noble Jones, Michael D Stubblefield

Current Physical Medicine and Rehabilitation Reports, 1-10, 2022

Purpose of Review

The purpose of the review is to detail the pathophysiology, clinical signs and symptoms, and evaluation and management of patients with radiation-induced plexopathy (RIP). The specific cancer types, radiation treatment techniques, and the associated plexus neuroanatomy most susceptible to injury will be discussed.

Recent Findings

The latest research has not demonstrated a way to predict which patients will develop RIP. There is, however, a strong correlation to dosing, anatomical exposure, and pattern of damage and symptomatology. While there is no cure for RIP, advances in radiation delivery techniques have, for the most part, effectively minimized plexus exposure and thus the incidence and severity of RIP. Various surgical and nonsurgical therapies have been described with largely disappointing results. Some interventions, such as surgically implanted diaphragmatic pacemakers to treat hemidiaphragmatic paralysis, the use of ultrasound, and/or electromyography-guided botox injections to treat hypertonic muscles, are helpful in some cases. Advances in imaging techniques have helped to more accurately determine whether developing neurologic symptoms are due to RIP or neoplasm.

Summary

Patients who receive high-dose radiation therapy that involves one of the body plexuses are at risk for developing RIP. Unfortunately, predicting the severity, time course of symptoms, and progression of RIP remains elusive. There is a growing awareness among the healthcare community of the acute and late effects of radiation therapy, specifically radiation-induced plexopathy. Because there is no meaningful way to slow or reverse the progression of RIP, management is largely symptomatic. Patients should be comprehensively evaluated, followed closely, and educated on the chronic and progressive nature of RIP. A multidisciplinary approach that involves multiple clinicians such as physiatrists, physical therapists, occupational therapists, lymphedema management practitioners, and other clinicians are often indicated.. Further research is needed to develop more targeted radiation therapy treatments, prophylaxis to prevent or minimize RIP, and ultimately treatments that effectively reverse RIP.

[Kentucky1 in reply to Graham49]

Thanks for the info, looking back at medical records I only received 44Gy total dose from the 2 sessions. Certainly not a high dose, so I guess I'll find out more once the neuro does more testing.