Article

Because of the improvement of cancer prognosis, long-term damages
of treatments become a medical and public health problem. Among the iatrogenic
complications, neurological impairment is crucial to consider since motor
disability and pain have a considerable impact on quality of life of long cancer
survivors. However, radiation-induced neuropathies have not been the focus of
great attention. The objective of this paper is to provide an updated review
about the radiation-induced lesions of the peripheral nerve system. STATE OF THE
ART: Radiation-induced neuropathies are characterized by their heterogeneity in
both symptoms and disease course. Signs and symptoms depend on the affected
structures of the peripheral nerve system (nerve roots, nerve plexus or nerve
trunks). Early-onset complications are often transient and late complications are
usually progressive and associated with a poor prognosis. The most frequent and
well known is delayed radiation-induced brachial plexopathy, which may follow
breast cancer irradiation. Radiation-induced lumbosacral radiculoplexopathy is
characterized by pure or predominant lower motor neuron signs. They can be
misdiagnosed, confused with amyotrophic lateral sclerosis (ALS) or with
leptomeningeal metastases since nodular MRI enhancement of the nerve roots of the
cauda equina and increased cerebrospinal fluid protein content can be observed.
In the absence of specific markers of the link with radiotherapy, the diagnosis
of post-radiation neuropathy may be difficult. Recently, a posteriori conformal
radiotherapy with 3D dosimetric reconstitution has been developed to link a
precise anatomical site to unexpected excess irradiation. PERSPECTIVES AND
CONCLUSION: The importance of early diagnosis of radiation-induced neuropathies
is underscored by the emergence of new disease-modifying treatments. Although the
pathophysiology is not fully understood, it is already possible to target
radiation-induced fibrosis but also associated factors such as ischemia,
oxidative stress and inflammation. A phase III trial evaluating the association
of pentoxifylline, tocopherol and clodronate (PENTOCLO, NCT01291433) in
radiation-induced neuropathies is now recruiting.
CI - Copyright (c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS