Radiation-Induced Lumbosacral Plexopathy Treatment & Management

Updated: May 24, 2019
  • Author: Rajesh R Yadav, MD; Chief Editor: Dean H Hommer, MD  more...
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Rehabilitation Program

Physical Therapy

Strengthening of lower extremity muscles, use of assistive devices for ambulation (eg, cane, walker), and gait training should be prescribed for patients with weakness and proprioceptive feedback loss. Use of orthotics also may be beneficial in certain individuals with lumbosacral plexopathy.

Occupational Therapy

The patient's ability to perform activities of daily living (ADL) should be assessed, and appropriate assistive device(s) should be prescribed as needed. In particular, safety with standing transfers may be impaired with more distal involvement. With more proximal involvement, sit-to-stand transfers also may be affected. Strengthening exercises, along with sensory reeducation techniques, may be employed.


Medical Issues/Complications

Treatment of radiation plexopathy is symptomatic. For issues of pain, consider the use of nonopiate pharmacologic medications, such as tricyclic antidepressants or antiepileptic agents (eg, gabapentin, carbamazepine). The use of steroids and opiates, including methadone, can also be assessed.


Other Treatment

Nonpharmacologic measures, such as transcutaneous electrical nerve stimulation (TENS), may be used for pain.

While not studied in patients with radiation-induced lumbosacral plexopathy, hyperbaric oxygen therapy has not led to the slowing or reversal of radiation-induced brachial plexopathy symptoms, although improvement was noted in warm sensory threshold. [20]

In a small population, partial recovery of motor function was noted in few patients treated with anticoagulant therapy for a period of 3-6 months.

A study by Tunio et al indicated that radiation-induced lumbosacral plexopathy can be reduced by delineating the lumbosacral plexus through imaging and administering intensity-modulated radiotherapy (IMRT) so that radiation dosages of 40, 50, 55, and 60 Gy are absorbed by less than 55%, 30%, 5%, and 0.5% of the lumbosacral plexus volume, respectively. The study involved 50 patients with cervical cancer who underwent IMRT and high-dose-rate brachytherapy. Four patients had developed grade 2/3 radiation-induced lumbosacral plexopathy by 60-month follow-up. [21]

A randomized, placebo-controlled, double-blind trial by Delanian et al indicated that although studies have reported that pentoxifylline/vitamin E (PENTO) treatment can lead to a significant decrease in radiation-induced fibrosis and that, in combination with clodronate (PENTOCLO), it permits progressive mandible osteoradionecrosis to heal and reduces some neurologic symptoms, PENTOCLO therapy has no significant benefit in radiation-induced plexopathy. However, the authors stated that more sensitive means are needed to detect whether investigational drugs can aid this condition. [22]