Radiation Myelopathy: A Review

Goldwein, Joel W.

doi:10.1016/0958-3947(88)90049-0

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…1-6 CPM frequently presents with functional deficits including sensory and motor abnormalities, bowel and bladder sphincter disturbance, and diaphragm dysfunction in high lesions. 2,6 The signs and symptoms may progress gradually to overt sensory deficit, paralysis, spasticity, and incontinence, or may stabilize at any level of partial neurologic deficit. 7 The frequency of CPM increases and latency decreases with higher doses of radiation treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The true frequency of CPM is difficult to determine and varies from <1% to as high as 12.5% among selected pa-tients. 6 Incidence is usually related to the total dose of radiation and the fraction size, with the risk being very low in patients receiving <6000 cGy in daily fraction of <200 cGy at a rate of about 900 cGy per week. 8 The pathogenesis of delayed nervous system injury is complex.…”

Section: Discussionmentioning

confidence: 99%

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Anticoagulation Therapy for Radiation-Induced Myelopathy

2001

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anticoagulation Therapy for Radiation-Induced Myelopathy

2001

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“…Radiation oncologists strive to avoid producing radiation myelopathy, and generally have restricted spinal cord dose to figures with a 5% chance of inducing this complication. The dosing schedule with a 5% risk has been estimated to be 4200-4500 cGy in 25 fractions [72,73]. However, current evidence suggests this may be an overly conservative estimate, and that the true risk with this schedule is 0.2%, whereas 6000 cGy in 30 fractions carries a 5% risk of radiation myelopathy [73].…”

Section: Radiation Myelopathymentioning

confidence: 99%

Spinal Cord Compression

Ribas

Schiff

2012

Curr Treat Options Neurol

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Spinal cord disease represents a major cause of morbidity and suffering in cancer patients. Prevention or minimization of neurologic deficits depends on an understanding of early symptoms, clinical course, and treatment options. Early diagnosis is crucial, as current treatments usually arrest the course of the disease but much less commonly restore lost neurologic function. This article will review the epidemiology, pathophysiology, symptomatology, diagnosis, and management of the causes of spinal cord dysfunction directly related to cancer. It will briefly discuss myelopathies related to paraneoplasia and treatment complications. Epidural spinal cord compressionSpinal cord or cauda equina dysfunction resulting from tumor growth in the spinal epidural space is commonly referred to as epidural spinal cord compression (ESCC). In some ways, spinal epidural metastasis (SEM) may be a better term, as it encompasses the phenomena of root, cauda equina, and minor degrees of thecal sac compression SEM/ESCC is the most common cause of spinal cord dysfunction in cancer patients, and will receive the bulk of attention in this article. EpidemiologyAlthough careful, contemporary population-based studies are unavailable, the best evidence suggests that 5% of patients dying of cancer have suffered ESCC [1]. With more than 500,000 Americans succumbing to cancer yearly, there are likely to be more than 25,000 cases of ESCC yearly in the United States.Neurol Clin N Am

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“…Recurrence of pain and nerve compression due to local tumor relapse after radiotherapy is a problem for long-term survivors of spinal metastases. Surgical treatment is often selected in these cases because repeat irradiation bears the risk of radiation myelopathy [ 8 , 9 ]. However, late-stage radiation injury is associated with perioperative complications, such as delayed wound healing or wound infection [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Radiation on Spinal Dura Mater and Surrounding Tissue in Mice

et al. 2015

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PurposeSpinal surgery in a previously irradiated field carries increased risk of perioperative complications, such as delayed wound healing or wound infection. In addition, adhesion around the dura mater is often observed clinically. Therefore, similar to radiation-induced fibrosis—a major late-stage radiation injury in other tissue—epidural fibrosis is anticipated to occur after spinal radiation. In this study, we performed histopathologic assessment of postirradiation changes in the spinal dura mater and peridural tissue in mice.Materials and MethodsThe thoracolumbar transition of ddY mice was irradiated with a single dose of 10 or 20 Gy. After resection of the irradiated spine, occurrence of epidural fibrosis and expression of transforming growth factor beta 1 in the spinal dura mater were evaluated. In addition, microstructures in the spinal dura mater and peridural tissue were assessed using an electron microscope.ResultsIn the 20-Gy irradiated mice, epidural fibrosis first occurred around 12 weeks postirradiation, and was observed in all cases from 16 weeks postirradiation. In contrast, epidural fibrosis was not observed in the nonirradiated mice. Compared with the nonirradiated mice, the 10- and 20-Gy irradiated mice had significantly more overexpression of transforming growth factor beta 1 at 1 week postirradiation and in the late stages after irradiation. In microstructural assessment, the arachnoid barrier cell layer was thinned at 12 and 24 weeks postirradiation compared with that in the nonirradiated mice.ConclusionIn mice, spinal epidural fibrosis develops in the late stages after high-dose irradiation, and overexpression of transforming growth factor beta 1 occurs in a manner similar to that seen in radiation-induced fibrosis in other tissue. Additionally, thinning of the arachnoid barrier cell layer was observed in the late stages after irradiation. Thus, consideration should be given to the possibility that these phenomena can occur as radiation-induced injuries of the spine.

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Radiation Myelopathy: A Review

Cited by 5 publications

References 21 publications

Anticoagulation Therapy for Radiation-Induced Myelopathy

Anticoagulation Therapy for Radiation-Induced Myelopathy

Spinal Cord Compression

Effects of Radiation on Spinal Dura Mater and Surrounding Tissue in Mice

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