Hyperbaric Oxygen Therapy: A Treatment for Radiation Induced Plexopathy (P3.4-027)

This article presents a case report highlighting the potential use of Hyperbaric Oxygen Therapy: A Treatment for Radiation Induced Plexopathy (RIP). RIP is a rare but severe side effect that occurs following radiation treatment for pelvic malignancies, leading to motor and sensory changes in the lower extremities. In the case of a 64-year-old man with a history of prostate cancer, HBO therapy was administered after he experienced progressive symptoms related to RIP. After completing 24 HBO treatments, the patient reported significant improvement, with the resolution of lower extremity and saddle anesthesia, as well as increased lower extremity strength. This suggests that HBO therapy may be a promising approach for managing RIP, which is traditionally considered irreversible, potentially improving the quality of life for affected patients.

Objective: To present a case report of hyperbaric oxygen as a potential therapy for radiation induced plexopathy.

Authors: G verma, C Goldschmidt, S Vaughan

Background: Radiation induced plexopathy results after radiation treatment is targeted at pelvic malignancies. It typically presents with motor and sensory changes in lower extremities (LEs), although, due to the various anatomic sites that are irradiated, the presentation can vary. RIP is a rare but severe side effect that can impact quality of life and is usually a diagnosis of exclusion. To date there is no effective treatment. We report a case in which hyperbaric oxygen (HBO) treated RIP.

Results: A 64-year-old man with history of prostate cancer status post 39 radiation treatments reported progressive bilateral LE parasthesias and weakness a few months after radiation. His examination showed mild diffuse weakness in bilateral LEs and decreased sensation in patchy distribution in bilateral LEs and saddle region. EMG showed bilateral thoracic radiculopathy, L5 radiculopathy and S1 radiculopathy. MRI of the entire spine was unremarkable. CSF analysis was negative for malignant, infectious or inflammatory etiologies. Therefore, symptoms were attributed to radiation induced plexopathy. He was started on hyperbaric oxygen therapy. After completing 24 treatments, patient reported improvement in symptoms. Bilateral lower extremity and saddle anesthesia had resolved. He also had improvement in lower extremity strength.

FAQs

1. What is radiation-induced plexopathy (RIP)?
   • Radiation-induced plexopathy is a condition that occurs as a rare side effect of radiation therapy for pelvic malignancies. It results in motor and sensory changes in the lower extremities and can significantly impact a patient’s quality of life.
2. What is hyperbaric oxygen therapy (HBOT)?
   • Hyperbaric oxygen therapy is a medical treatment that involves breathing pure oxygen in a pressurized chamber. It is used to treat a variety of medical conditions, including those related to the effects of radiation therapy.
3. What is the significance of the article titled “Hyperbaric Oxygen Therapy: A Treatment for Radiation Induced Plexopathy (P3.4-027)”?
   • The article presents a case report and discusses the potential use of hyperbaric oxygen therapy as a treatment for radiation-induced plexopathy, a condition for which there is currently no established effective treatment.
4. What are the typical symptoms of radiation-induced plexopathy (RIP)?
   • RIP often presents with symptoms such as motor and sensory changes in the lower extremities, bilateral leg weakness, and changes in sensation in the legs and saddle region.
5. How common is radiation-induced plexopathy?
   • RIP is considered a rare side effect of radiation therapy, but its incidence has increased due to improving survival rates among cancer patients.
6. What was the patient’s experience mentioned in the article?
   • The article discusses the case of a 64-year-old man who had a history of prostate cancer and developed progressive symptoms of radiation-induced plexopathy after receiving radiation treatment. He underwent hyperbaric oxygen therapy and reported significant improvement in his symptoms.
7. Is radiation-induced plexopathy reversible?
   • RIP is generally considered irreversible, and management typically involves supportive care to alleviate symptoms. However, the article suggests that hyperbaric oxygen therapy may offer a promising approach for improving the condition.

Conclusions: 

Radiation-induced plexopathy (RIP) is a rare side effect of radiation that can lead to significant disability and difficulty in performing activities of daily living. Due to increasing survival rates of cancer patients, the incidence of RIP has increased as well. At this time, RIP is typically thought to be irreversible and management is primarily supportive care. Our patient with RIP was treated with hyperbaric oxygen therapy and had significant improvement in symptoms. Given the impairment in function this condition can cause, we suggest a trial of HBO be considered for all patients with RIP.