Cardiac Toxicity After Craniospinal Irradiation: A Late Effect That May be Eliminated With Proton Therapy

Craniospinal irradiation (CSI) is commonly required for pediatric patients with central nervous system malignancies. Traditionally, CSI is given using x-rays to deliver radiation to the brain and spine, exposing normal anterior structures, including heart, to unnecessary radiation.

We present a patient treated with x-ray CSI for medulloblastoma with spinal metastasis (3600 cGy CSI with focal boost to 5000 cGy), who subsequently developed significant cardiac toxicity, likely related to radiation exposure.

Spinal irradiation can cause significant cardiac risk due to exit dose through anterior structures. This toxicity may be avoided with proton therapy, which eliminates visceral exit dose.