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Myelopathy with severe structural derangement associated with combined modality therapy
Cancer
|November 1, 1983
Summary
Radiation and chemotherapy can cause myelopathy, a spinal cord complication. This case suggests a synergistic effect between radiation and intrathecal methotrexate in a pediatric medulloblastoma patient, leading to severe spinal cord damage.
Area of Science:
- Neuro-oncology
- Neuropathology
Background:
- Myelopathy is a recognized complication of spinal irradiation.
- The role of chemotherapy, particularly intrathecal methotrexate, in causing myelopathy is less understood.
Observation:
- A 12-year-old boy with medulloblastoma developed extensive myelopathy.
- This occurred despite receiving accepted doses of intrathecal methotrexate and spinal irradiation.
Findings:
- Postmortem examination revealed profound leptomeningeal fibrosis and spinal cord necrosis.
- These pathological changes suggest a synergistic toxic effect between radiation and methotrexate.
Implications:
- This case highlights a potential severe adverse effect of combined radiation and chemotherapy for medulloblastoma.
- Further research is warranted to understand and mitigate this synergistic myelopathy risk.