Delayed radiation necrosis of brainstem related to fast neutron beam irradiation.Case report and literature review

Abstract

A 42-year-old man developed necrosis of the brainstem 10 months following fast neutron irradiation of a recurrent adenocystic carcinoma of the right submandibular salivary gland. The neoplasm had been diagnosed 15 years earlier.Neck dissection and several local excisions failed to control local extension, so that 7000 rad 4.8 MeV x-rays were administered. The right mandible and part of the tongue and palate were resected for recurrence and chemotherapy and transfer factor were given. Because of cranial neuropathy and erosion of the skull base, fast neutron radiation (2.080 rads) was administered five and one-half years after the x-ray therapy, but to a nonoverlapping field. Ten months later, rapidly progressive symptoms and signs of multiple cranial nerve palsies on the right side and left hemihypestbesia and hemiplegia appeared. Clinical manifestations of brainstem necrosis lasted 4 months. Postmortem examination demonstrated radionecrosis of pons and upper medulla, predominantly on the right side. This case illustrates the efficacy of neutron radiatios in eradicating local carcinoma and also the serious complications of this therapeutic modality.

Brainstem auditory evoked potentials after irradiation of nasopharyngeal carcinoma—Report on two cases with myelopathy of the brainstem

“…Radiation has a damaging effect on the middle ear (Gyorkey and Pollock 1960, Schuknecht and Karmody 1966, Elwany 1985, the cochlear and cochlear nerve fibre (Bohne et ai, 1985) stem is a recognized, rare late complication after radiotherapy for extracranial head and neck malignancy (Berge et al, 1974;Manz et al, 1979;Smith et al, 1979). Brainstem auditory evoked potential (BAEP) is widely used for the diagnosis of brainstem pathology.…”

“…BAEP findings are shown in Tables II and III and Figure 4. On stimulation of the right ear, the latencies of waves I and V were 1.82 msec ad 6.93 msec respectively, with a I-V wave interval of 5.11 msec (prolongation was greater than 4.5 standard devia- and neck malignancies and onset of symptom of radionecrosis of brain stem varies from three to 26 months (Manz et al, 1979). Radionecrosis of the brainstem usually manifests itself as blindness, multiple cranial nerve palsies, hemiparesis, hemisensory deficit, and ataxia (Berge ef al., 1974;Manz etal., 1979;Lampert and Davis, 1964).…”

Delayed Cerebral Radiation Necrosis after Neutron Beam Radiation of a Parotid Adenocarcinoma: A Case Report and Review of the Literature

“…The patient recovered uneventfully and was asymptomatic seven months after surgery. Manz et al described a 42-year-old male with a history of recurrent adenocystic carcinoma of the right submandibular gland [ 10 ]. He had undergone adjuvant radiation with a calculated tumor dose of 2.080 neutron plus gamma rads to the skull base in 26 fractions.…”

Spontaneous Intracerebral Hemorrhage: A Very Late Delayed Effect of Radiation Therapy

“…Other vascular alterations, taking the form of large irregular telangiectatic dilations of the small capillaries, can occur. 4,5,[7][8][9][10][11] The histologic changes produced by radiation resemble those seen in vascular malformations. In arteriovenous malformations, there are large numbers of abnormally structured blood vessels.…”