Gabriel O. López Medrano, BS
MS4
Ponce Health Sciences University
Bayamon, Puerto Rico, United States
Sara kurtevski, MD
Resident Physician
University of Miami/ Jackson Health System
Miami, Florida, United States
Diana M. Molinares Mejia, MD
Attending Physician
Jackson Memorial Hospital/University of Miami
Miami, FL, Florida, United States
Radiation-induced sciatic neuritis
Case Description:
A 63-year-old woman with right iliac wing lesion secondary to diffuse large B-cell lymphoma treated with R-CHOP chemotherapy regimen and consolidation radiation (36Gy) in 2020 presented to cancer rehabilitation clinic in 2022 with complaint of low back pain and neurogenic claudication-like symptoms. MRI of lumbar spine was obtained without evidence of lumbar stenosis which was treated conservatively. At follow-up, symptoms progressed to more noticeable right leg allodynia, numbness, and weakness. Examination revealed newly diminished sensation over the right lateral foot, and asymmetrically absent right S1 reflex. Pentoxifylline and vitamin E was started for treatment of suspected radiation induced neuropathy. MR neurography showed asymmetric enlargement and increased T2 signal of the right sciatic nerve as well as radiation-induced myositis in the right gluteal musculature confirming the diagnosis of sciatic neuritis. Treatment with pentoxifylline and vitamin E was successful and symptoms resolved.
Discussions:
Radiation induced peripheral neuropathy is a potentially debilitating complication of radiation therapy with unclear treatment guidelines. Pathophysiology is still debated; however, initial microvascular injury with direct injury to nerves and blood vessels as well as an inflammatory cascade and fibrosis seem to contribute to delayed progressive injury, which can present years after treatment completion. Majority of reported cases involve brachial plexopathy, with peripheral mononeuropathy rarely reported especially in lower extremities. Highlighted here is a rare diagnosis of radiation induced sciatic neuritis presenting two years after completed radiation treatment. By combining pentoxifylline (a vasodilator) and vitamin E (antioxidant and anti-inflammatory) to address the underlying pathophysiology, the patient’s symptoms resolved.
Conclusions:
As oncological treatments continue to evolve, there is an increasing need for cancer rehabilitation that focuses on recognizing and addressing therapy-related sequelae to prevent functional decline. The outcomes suggested by this study indicate that vitamin E and pentoxifylline are promising therapies for radiation-induced neuropathy, offering significant symptom relief.
