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Peripheral Nerve Compression Syndromes Following Cancer Treatment

Dr. Andrew Elkwood, Dr. Michael Rose, and Dr. Eric Chang recently published an article in the Journal of Surgical Oncology about peripheral nerve compression syndromes following chemotherapy and radiation treatment. In this article, they explain what these syndromes are and how microsurgical nerve techniques can be used to alleviate symptoms.

Treatment plans for cancer often involve multiple modalities to achieve the best overall outcomes. This may include surgical intervention, radiation, and chemotherapy. While chemotherapy and radiation are crucial in the treatment algorithm for many types of cancer, there are a number of associated risks and complications. Peripheral neuropathy is one of the potential complications occurring after chemotherapy. Up to 30% of cancer patients will experience persistent neuropathy long after the completion of treatment. Radiation-induced brachial plexopathy is another rare adverse side effect due to therapy for malignancy. As survivorship after cancer treatment continues to increase, we also expect to see a greater volume of patients diagnosed with chemotherapy-induced neuropathy and radiation-induced brachial plexopathy.

Neuropathy is a chronic condition that results from damage to or compression of the nerves outside the spinal cord and brain. Chemotherapy may cause damage to nerves that can lead to neuropathy. Common symptoms of chemotherapy-induced neuropathy include pain, burning, numbness, tingling, and weakness, usually in the hands or feet. Pain medications may provide symptom relief but do not address the underlying cause of neuropathy.

Surgical treatment of peripheral neuropathy as a result of chemotherapy relies on the same techniques used to treat neuropathy due to other causes. Neuropathy surgery actually addresses the underlying cause of the neuropathy symptoms. This procedure is performed on an outpatient basis and involves relieving the pressure on a nerve by surgically removing the constricting tissue or widening the canal surrounding the nerve. Surgical decompression of peripheral nerves has been shown to alleviate the symptoms of chemotherapy-induced peripheral neuropathy, allowing patients to return to their everyday activities.

For many cancer patients, their course of treatment may require radiotherapy in addition to chemotherapy. Radiotherapy may result in injury to nerves, but symptoms may not appear until years after treatment. The brachial plexus is a large, complex bundle of nerves in the shoulder passing down to the arm and hand that may be damaged during radiation therapy for head and neck cancers, lung cancer, and breast cancer. Radiation-induced brachial plexopathy may cause devastating impairments, including loss of strength, decreased range of motion, severe pain, and even paralysis of the arm.

Depending upon its seriousness, treatments for brachial plexus injury range from physical therapy and medications that relieve inflammation to surgical brachial plexus reconstruction to relieve pressure on the nerves or even replace the nerves. Multiple microsurgical reconstruction techniques can be used to treat brachial plexopathy from radiation damage to alleviate pain and restore function.

Chemotherapy-induced peripheral neuropathy and radiation-induced brachial plexopathy are two extremely debilitating side effects that can cause significant disability in cancer survivors. However, there are surgical treatments available that can provide patients relief from these conditions and provide an improved quality of life.

Click here to read the full article, Microneurosurgical treatment options in peripheral nerve compression syndromes after chemotherapy and radiation treatment.