PALLIATIVE REIRRADIATION WITH AN ACCUMULATED DOSE OF 80 GY FOR PAINFUL BRACHIAL PLEXUS METASTASIS AFTER 60 GY IRRADIATION FOR LYMPH NODE METASTASIS OF BREAST CANCER : A CASE REPORT

The rare condition of brachial plexus metastasis (BPM) from malignant carcinoma causes extreme pain and can limit activities of daily living. A few reports have indicated that palliative irradiation is an effective and safe treatment for BPM ; however, the efficacy and safety of reirradiation for BPM are not well-known. In the present report, we describe the case of a patient with BPM of breast cancer who had a history of receiving 60 Gy of irradiation in 30 fractions to bilateral subclavian areas to treat lymph node metastases, developed extremely painful BPM in the primary irradiated area, and underwent further irradiation with 20 Gy in five fractions. This palliative reirradiation initially resulted in significant pain relief, and the tumors reduced in size immediately after the treatment. Regrowth of the tumors and recurrence of the pain occurred five months after irradiation ; however, further irradiation was not administered as it could be associated with a high risk of plexopathy or myelopathy. This case report describes the tolerability and effectiveness of reirradiation for BPM, the decision process of reirradiation, and the usefulness of modern diagnostic imaging for deciding radiation field and technique to deliver safe and effective reirradiation