Surgical Treatment of Radiation-Induced Brachial Plexus Neuropathy in Breast Cancer Patients after Adjuvant Radiotherapy: A Systematic Review

TL;DR

This review examines surgical treatments for a nerve condition caused by radiation in breast cancer patients, finding some options help with pain but more research is needed.

Contribution

The paper systematically reviews surgical interventions for radiation-induced brachial plexus neuropathy in breast cancer patients.

Findings

External neurolysis improved pain in 81.8% of patients, though some experienced worsened motor strength.

Segmental nerve resection with autografting and cervical thoracic laminectomy enhanced both pain and motor function.

Surgical techniques like nerve transfer and free muscle transfer showed variable recovery and pain relief outcomes.

Abstract

Radiotherapy is a frequently employed adjuvant treatment modality in breast cancer patients that carries debilitating side effects including radiation-induced brachial plexus neuritis (RIBPN). RIBPN is a neurological impairment that occurs following radiation exposure and causes pain, paresthesia, and weakness. The goal of this study is to review literature on surgical treatments for RIBPN and explore areas for further investigation.

A comprehensive search of PubMed, SCOPUS and Embase databases was conducted using search terms related to RIBPN. The authors reviewed the titles, abstracts, and full texts to identify those that discussed surgical management of RIBPN in breast cancer patients. Out of 306 studies, 9 articles met inclusion criteria and were reviewed (Fig. 1).

41 patients were treated surgically for RIBPN, with six distinct surgical techniques employed. External neurolysis was the most common treatment, benefiting 81.8% of patients with improvements in pain, although some patients experienced worsening motor strength. Techniques like segmental nerve resection with autografting and cervical thoracic laminectomy significantly enhanced pain and motor function. Other techniques including neurolysis with nerve transfer and gracilis-free muscle transfer provided varying degrees of recovery and pain relief.

Our review highlights that while neurolysis, whether alone or combined with nerve transfer, free muscle transfer, or omentoplasty, and other methods including nerve grafting or dorsal root lesions offer surgical treatment options for RIBPN, these modalities are not well studied. Further investigation into the efficacy of these options and alternative surgical treatments may be warranted to improve outcomes among breast cancer patients.

The online version contains supplementary material available at 10.1007/s43465-025-01540-0.

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