Radiation-Induced Lumbosacral Plexopathy Clinical Presentation

  • Author: Rajesh R Yadav, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Dec 6, 2011
 

History

With prior radiation treatment and initial symptoms, a recurrent tumor may need to be distinguished from postradiation plexopathy. The median symptom-free interval for radiation-induced lumbosacral plexopathy, from treatment to the initial neurologic symptom, is 5 years, with a range of 1-31 years.[2]

  • Patients with radiation-induced lumbosacral plexopathy most commonly present with painless weakness in 1 or both legs. Pain is present initially in only 10% of patients, although ultimately it is noted in as many as 50% of patients. The incidence of initial pain is lower than that of brachial plexopathy. This pain is described in varying terms, such as aching, burning, pulling, cramping, and lancinating; however, pain rarely is a major problem.
  • Weakness is asymmetrical. At the height of illness, the ratio of bilateral to unilateral illness is 5:1. Acute lower extremity paralysis has been noted in a patient with cervical cancer 10 weeks after completion of radiation treatment.[4]
  • Sensory loss occurs in 50-75% of patients and is more severe with greater motor impairment, which can add significantly to disability.
  • Bladder or bowel incontinence may occur.[5]
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Physical

  • In radiation-induced lumbosacral plexopathy, motor deficits in the lower extremities commonly are bilateral (80%) and asymmetrical. Diffuse limb weakness with distal predominance in L5-S1 distribution is relatively common (55% of patients). Exclusive proximal paresis in the distribution of L2-L4 is less common (10% of patients), as is femoral neuropathy (5% of patients). Moderate weakness is present in 50% of patients, with equal distribution of mild and severe weakness.
  • Deep tendon reflexes (DTRs) almost always are abnormal at the knees and/or ankles and usually are present bilaterally.
  • Sensory impairments are present in most patients (75%) and more often are bilateral. No specific sensory modality is favored. The distal lower extremities are affected more commonly than are the proximal lower extremities. Impaired deep sensation occurs with severe, superficial sensory loss.
  • Skin changes may be present in areas of radiation portals.
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Causes

Radiation dosage, treatment technique, and concomitant use of chemotherapy are associated with development of radiation-induced lumbosacral plexopathy.

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Contributor Information and Disclosures
Author

Rajesh R Yadav, MD  Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Kaplan, MD  James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References

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  4. Abu-Rustum NR, Rajbhandari D, Glusman S, et al. Acute lower extremity paralysis following radiation therapy for cervical cancer. Gynecol Oncol. Oct 1999;75(1):152-4. [Medline].

  5. Iglicki F, Coffin B, Ille O, et al. Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case. Dis Colon Rectum. Apr 1996;39(4):465-7. [Medline].

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  9. Abdellaoui A, West NJ, Tomlinson MA, et al. Lower limb paralysis from ischaemic neuropathy of the lumbosacral plexus following aorto-iliac procedures. Interact Cardiovasc Thorac Surg. Aug 2007;6(4):501-2. [Medline]. [Full Text].

  10. Moskovic E, Curtis S, A'Hern RP, et al. The role of diagnostic CT scanning of the brachial plexus and axilla in the follow-up of patients with breast cancer. Clin Oncol (R Coll Radiol). Mar 1992;4(2):74-7. [Medline].

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  14. Pritchard J, Anand P, Broome J, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol. Mar 2001;58(3):279-86. [Medline].

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  16. Bradley WG, Fewings JD, Cumming WJ, et al. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat. J Neurol Sci. Jan-Feb 1977;31(1):63-82. [Medline].

  17. Cavanagh JB. Prior x-irradiation and the cellular response to nerve crush: duration of effect. Exp Neurol. Oct 1968;22(2):253-8. [Medline].

  18. Dahele M, Davey P, Reingold S, et al. Radiation-induced lumbo-sacral plexopathy (RILSP): an important enigma. Clin Oncol (R Coll Radiol). Jun 2006;18(5):427-8. [Medline].

  19. Glantz MJ, Burger PC, Friedman AH. Treatment of radiation-induced nervous system injury with heparin and warfarin. Neurology. Nov 1994;44(11):2020-7. [Medline].

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