Gj. Frykholm et al., ACUTE LUMBOSACRAL PLEXOPATHY DURING AND AFTER PREOPERATIVE RADIOTHERAPY OF RECTAL ADENOCARCINOMA, Radiotherapy and oncology, 38(2), 1996, pp. 121-130
Citations number
46
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
The benefit of preoperative radiotherapy of adenocarcinoma of the rect
um with respect to a reduced local recurrence rate and an improved sur
vival should be weighed against adverse effects. For 14 years a three-
beam, isocentric technique was employed at our hospital to deliver fiv
e fractions (5.0 or 5.1 Gy), over 5 or 7 days preoperatively, to patie
nts with rectal cancer which was considered primarily resectable. The
adverse effects of the radiotherapy were few, but acute pain and subac
ute neurological symptoms and signs did occur. An apparent increase in
the frequency of these symptoms/signs was noted during 1993. The pain
and neurological symptoms are described in case reports and the indiv
idual treatments are reviewed. The three-beam technique was analyzed i
n detail with individual, CT-based, three-dimensional dose-planning an
d dose distributions in the vicinity of the lumbar nerve plexus are pr
esented. The major result of this analysis showed that technical error
s could be excluded, that human errors were unlikely, and that the cul
prit probably was an unexpected sensitivity to marginal changes in the
daily dose and unknown or unexpected radiosensitizing effects of conc
urrent diseases or medication.