Melek Nur YAVUZ, Erkan TOPKAN, Hüseyin Cem ÖNAL, Ali Aydın YAVUZ

Pathophysiology and management of radiation-induced lumbosacral plexopathy

Radyasyona bağlı lumbosakral pleksus hasarı, karın, pelvis ve retroperiton bölgesinden köken alan primer tümörlerin veya bu bölgeleri tutan metastatik tümörlerin radyoterapisi (RT) ardından ender görülen, hasta yaşam kalitesini olumsuz yönde etkileyen bir yan etkidir. Radyasyona bağlı lumbosakral pleksus hasarının oluşum nedenleri tam olarak açıklığa kavuşturulamamış olmasa da öne sürülen mekanizmalar akson hasarına neden olan radyasyon nedenli vasküler hasar ve radyasyon fibrozisi sonrası vasküler yapılar ve sinirlerin sıkışması şeklinde açıklanmaktadır. Klinik tablonun gelişiminde etkisi olabilecek faktörler, fraksiyon büyüklüğü ve toplam radyasyon dozu, RT tekniği, radyasyon duyarlaştırıcılarının kullanımı, eşzamanlı kemoterapi uygulanması ve özellikle intraoperatif veya intrakaviter RT şeklinde bildirilmektedir. Bu yazıda, oldukça nadir bir klinik durum olan radyasyona bağlı lumbosakral pleksus hasarının patofizyolojik ve klinik özellikleri, ayırıcı tanıda yer alan hastalıklar ve tedavi seçenekleri son literatür bilgileri ışığında özetlendi.

Radyasyona bağlı lumbosakral pleksus hasarının patofizyolojisi ve tedavi seçenekleri

Radiation-induced lumbosacral plexopathy (RILP) is a rare but severely debilitating side effect of abdominopelvic irradiation, which is used in the management of a myriad of primary and metastatic tumors involving the abdominal, pelvic and retroperitoneal regions. Although the exact mechanism of RILP is not yet clearly elucidated, postulated mechanisms include radiation-induced vascular injury and radiation fibrosis leading to axonal damage and entrapment of nerves/small vessels, respectively. Effects of radiation are suggested to be correlated to the dose per fraction and total dose of radiation therapy (RT), use of radiosensitizing agents, RT technique, and concurrent administration of chemotherapy. Furthermore, the risk of RILP occurrence particularly increases with intracavitary and intraoperative brachytherapy applications. In the current review, we aimed to summarize the latest literature considering aspects of the pathophysiology, clinical features differential diagnosis, and treatment of this debilitating complication.

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