Disclosures: Elana Hartman, MD: Nothing to disclose

Case Description: At age 16, patient was diagnosed with dysgerminoma with periaortic node metastases. She underwent hysterectomy with bilateral salpingo-oophorectomy followed by AP/PA radiation therapy (which included 2820 rads in 16 fractions to mediastinum and bilateral supraclavicular lymph nodes). 15 years after radiation therapy patient developed mid-back and rib pain. She was initially diagnosed with fibromyalgia and myofascial pain syndrome and treated conservatively. However, pain persisted and began to interfere with ADLs. She underwent MRI cervical and thoracic spine with no significant abnormalities. Given persistent pain, she was referred to a physiatrist who made the diagnosis of radiation fibrosis syndrome in the setting of overlapping radiation fields. Given failed conservative treatment, botulinum toxin A was injected along the thoracic paraspinal muscles.

Setting: Outpatient Rehabilitation Clinic

Patient: 51-year-old female with radiation fibrosis syndrome after radiation therapy for metastatic ovarian cancer.

Assessment/Results  Patient reported 5 weeks of complete pain resolution. At 8 weeks the pain returned but to a lesser extent. She continued with adjunct acupuncture, deep tissue massage and physical therapy. After two treatments she reported decreased need for opioids.

Discussion: Late complications of radiation therapy can manifest years after treatment and can result in debilitating side effects, which often go misdiagnosed if clinicians are not aware of this potential complication. The use of botulinum toxin A injections has been shown to be beneficial in the treatment of radiation fibrosis syndrome, however, the research is ongoing and there is limited reports of its use in the thoracic paraspinal muscles.

Conclusion: Clinicians should be aware of the side effects of radiation therapy and its extended time course, as these complications can manifest years after treatment and be debilitating. Clinicians must also be prepared to treat these symptoms with multiple modalities, of which, Botulinum toxin A injections can be considered as adjunct therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-radiation-fibrosis-syndrome-treated-with-botulinum-toxin-injections-a-case-report/