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Related Experiment Videos

Transverse myelitis after therapy for primitive neuroectodermal tumors.

Nicole J Ullrich1, Karen Marcus, Scott L Pomeroy

  • 1Department of Neurology, Children's Hospital Boston and Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. nicole.ullrich@childrens.harvard.edu

Pediatric Neurology
|August 1, 2006
PubMed
Summary

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High-dose chemotherapy with autologous stem cell rescue can cause transverse myelitis in children with malignant primitive neuroectodermal tumors. The timing of radiation therapy relative to chemotherapy may be crucial in preventing this side effect.

Area of Science:

  • Pediatric Oncology
  • Neuro-oncology
  • Radiation Oncology

Background:

  • Malignant primitive neuroectodermal tumors (PNETs) in children traditionally treated with surgery, chemotherapy, and radiation have a poor prognosis.
  • Novel therapeutic strategies involve high-dose chemotherapy followed by autologous stem cell rescue (HDC-ASCR) to improve outcomes.
  • Conventional treatments and newer approaches carry risks of significant, sometimes unanticipated, side effects.

Observation:

  • This report details two pediatric cases of treatment-related transverse myelitis (TM).
  • Both patients received induction chemotherapy and craniospinal irradiation, followed by HDC-ASCR.
  • TM is a rare but serious neurological complication potentially linked to the treatment regimen.

Findings:

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  • The occurrence of TM in these cases suggests a potential link to the specific sequence and timing of craniospinal irradiation and HDC-ASCR.
  • Patients treated with similar strategies but varied timing did not develop TM, highlighting the importance of treatment sequencing.
  • Radiation-induced central nervous system damage, including TM, may be influenced by the interplay between radiation dose, timing, and chemotherapy agents.

    • Implications:

    • The findings underscore the critical importance of optimizing the timing of radiation therapy in pediatric PNET treatment protocols to mitigate the risk of neurological toxicities like TM.
    • Further investigation into the neurotoxicity of combined modality treatments in pediatric oncology is warranted.
    • This case series may inform future treatment guidelines and risk-benefit analyses for pediatric PNET management.