Dosimetric Predictors and Risk Factors for Vertebral Column Degeneration and Paraspinal Neuropathic Pain Following Radiotherapy in Breast Cancer Patients

Introduction: Adjuvant breast radiotherapy frequently delivers off-target doses to the axial skeleton and paraspinal soft tissues, inducing insidious osteoskeletal degeneration and chronic neuropathic pain. Despite their clinical relevance, dosimetric thresholds governing these late sequelae remain poorly defined. This prospective study aimed to identify specific dosimetric predictors and independent clinical risk factors associated with vertebral degeneration and paraspinal neuropathic pain in breast cancer survivors. Material and methods: This prospective observational cross-sectional study at Shahid Madani Hospital investigated 175 breast cancer survivors sampled via convenience methods, evaluating cervicothoracic musculoskeletal and neurological disorders through standardized clinical examinations, functional assessments, and dosimetric data analysis. Results: This study revealed a high prevalence of cervicothoracic disorders in breast cancer survivors (myofascial pain: 50.3%; cervical ROM limitation: 43.4%), with supraclavicular irradiation (adjusted OR=2.87, P=0.003) and axillary dissection (adjusted OR=2.18, P=0.024) identified as significant independent risk factors. Conclusion: Radiation therapy and surgical interventions for breast cancer significantly increase the burden of cervicothoracic musculoskeletal and neurological morbidities. Optimizing radiation field design and minimizing paraspinal exposure are crucial to improving long-term survivorship quality of life.