Radiation-Induced Lumbosacral Plexopathy 

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

Background

Lumbosacral plexopathy can result when radiation, used in the treatment of various neoplasms, is directed toward management of abdominal and pelvic malignancies.

Anatomically, the lumbosacral plexus consists of lumbar (L1-L4) and sacral (L5-S5) portions, which are connected by the lumbosacral trunk (L4-L5). The L1-L4 nerve roots transverse through the psoas muscle and then coalesce into the lumbar plexus, which then divides into anterior and posterior divisions. The first 3 nerves (iliohypogastric, ilioinguinal, and femoral) of the 7 major branches of lumbar plexus provide motor and sensory innervation to the abdominal wall. The next 3 nerves (lateral femoral cutaneous, femoral, and obturator) innervate the anteromedial thigh. The femoral nerve terminates in the saphenous nerve providing sensation along the medial aspect of the leg.

The sacral plexus also divides into anterior and posterior divisions, which further divide into various peripheral nerves, providing sensory motor innervation to posterior hip girdle, thigh, and anterior and posterior leg. The 5 main nerves are the superior gluteal, inferior gluteal, posterior femoral cutaneous, sciatic, and pudendal. The sciatic nerve divides into the common peroneal and tibial nerves in the thigh.

Related eMedicine topics:

Radiation-Induced Brachial Plexopathy

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Pathophysiology

The effects of radiation are correlated with the dose, technique, and concomitant use of chemotherapy. Risk particularly increases with intracavitary radiation.[1] The mechanism may be related to a combination of localized ischemia and subsequent soft-tissue fibrosis due to microvascular insufficiency. With doses above 1000 cGy, pathologic changes can be seen in Schwann cells, endoneurial fibroblasts, vascular cells, and perineural cells. Injury to anterior and posterior nerve roots in rodents has been shown with doses of 3500 Gy. However, combined modality therapy may alter predicted tolerability and potential for late effects.

Radiation-induced lumbosacral plexopathy is particularly noted with uterine, cervical, ovarian, and testicular cancers, as well as with lymphomas.

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Epidemiology

Frequency

United States

Radiation-induced lumbosacral plexopathy is rare (0.3-1.3% of patients treated with radiation). It was noted in 1.3% of patients after abdominal irradiation and in 0.32% of patients after pelvic irradiation.

International

The international incidence of radiation-induced lumbosacral plexopathy is unknown.

Mortality/Morbidity

Generally, the symptoms of radiation-induced lumbosacral plexopathy progress gradually and with variable rapidity. Clinical manifestations of the condition have appeared 3 months to 22 years after the completion of radiation therapy.[2] Jaeckle and colleagues found that 20% of patients developed moderate or even severe weakness over 6 months.[3] Others were found to have mild weakness at 4-5 years following the onset of neurologic symptoms.

Race

No race predilection for radiation-induced lumbosacral plexopathy has been reported.

Sex

The male-to-female ratio is 1:1.2.

Age

Age at the time of presentation ranges from 34-68 years, with a median age of 47.5 years.

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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

  1. Pettigrew LC, Glass JP, Maor M, et al. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer. Arch Neurol. Dec 1984;41(12):1282-5. [Medline].

  2. Ashenhurst EM, Quartey GR, Starreveld A. Lumbo-sacral radiculopathy induced by radiation. Can J Neurol Sci. Nov 1977;4(4):259-63. [Medline].

  3. Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology. Jan 1985;35(1):8-15. [Medline].

  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].

  6. Jaeckle KA. Neurological manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. Dec 2004;24(4):385-93. [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].

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  22. Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology. Jan 1985;35(1):1-7. [Medline].

 
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