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[Radiation-induced myelitis following accelerated radiotherapy]
J Dunst1, U Dunst, W Wittmoser
1Strahlentherapeutische Klinik, Universität Erlangen-Nürnberg.
Summary
Radiation-induced myelitis is a rare complication, even with high doses of radiation therapy for oropharyngeal cancer. This case highlights the importance of monitoring for neurological symptoms after treatment.
Area of Science:
- Radiation oncology
- Neurology
- Oncology
Background:
- Oropharyngeal cancer treatment often involves high-dose radiotherapy.
- Twice-daily radiotherapy fractionation is used in some treatment protocols.
- Spinal cord tolerance to radiation is a critical factor in treatment planning.
Observation:
- A patient with oropharyngeal cancer received twice-daily radiotherapy (1.8 Gy per fraction) to a total dose of 70.2 Gy.
- The spinal cord received a total dose of 45.8 Gy (42 Gy direct + 3.8 Gy scatter).
- Six months post-treatment, the patient developed tetraparesis with cervical spinal cord lesions on MRI.
Findings:
- The patient's symptoms were diagnosed as radiation-induced myelitis.
- This is the first reported case of radiation myelitis in 90 patients treated with twice-daily fractionation at this institution.
- The incidence is low compared to over 2000 patients treated with conventional fractionation.
Implications:
- High-dose, fractionated radiotherapy requires careful spinal cord dose monitoring.
- Radiation-induced myelitis can occur even with modern techniques and doses.
- Further research into spinal cord radiation tolerance and predictive factors for myelitis is warranted.