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.^[22]

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.^[23]

In a placebo-controlled, double-blind study of adults with radiation-induced upper or lower limb plexopathy, Delanian et al found no significant benefit to PENTOCLO (pentoxifylline 800 mg, tocopherol 1000 mg, clodronate 1600 mg 5 days per week) treatment, with regard to pain and paresthesia. Evaluation was made via the Subjective Objective Management Analytic (SOMA) score.^{[24, 25]}

Medication

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Yi SK, Mak W, Yang CC, Liu T, Cui J, Chen AM, et al. Development of a standardized method for contouring the lumbosacral plexus: a preliminary dosimetric analysis of this organ at risk among 15 patients treated with intensity-modulated radiotherapy for lower gastrointestinal cancers and the incidence of radiation-induced lumbosacral plexopathy. Int J Radiat Oncol Biol Phys. 2012 Oct 1. 84(2):376-82. [QxMD MEDLINE Link].
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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. 2007 Aug. 6(4):501-2. [QxMD MEDLINE Link]. [Full Text].
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Masakado Y, Kawakami M, Suzuki K, et al. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med. 2008 Jun. 57(2):84-9. [QxMD MEDLINE Link].
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. 2001 Mar. 58(3):279-86. [QxMD MEDLINE Link].
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