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The incidence of brachial plexopathy in reported series for breast conservation is very low. Pierce et al. from the Harvard group reported 20 (1.2%) of 1624 patients developed brachial plexopathy. The median time to occurrence was 10 months (range 1.5—77 months) and in 17 (85%), the symptoms had completely resolved by 1—2 years. Three women had severe, progressive symptoms for an overall rate ofpermanent brachial plexopathy of approximately 0.2%.138 Supraclavicular/axillary radiation, axillary dose, and the use of chemotherapy were significantly associated with the development of brachial plexopathy. The 1117 patients treated with supraclavicular/axillary field developed brachial plexopathy in 1.8%, compared to none in the 507 patients treated to the breast alone (P < 0.009). Of those women who received nodal irradiation, higher rates of brachial plexopathy were seen with axillary doses >50 Gy (5.6% vs. 1.3%, P = 0.004), and the use chemotherapy (4.5% vs. 0.6%, P < 0.001). Other retrospective series ofBCT from single institutions confirm that brachial plexopathy is very rare when just breast irradiation is delivered.78'139'140

Table 15. Hypofractionated supraclavicular/axillary irradiation and brachial plexopathy

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