Elsevier

Neurologic Clinics

Volume 21, Issue 1, February 2003, Pages 249-277
Neurologic Clinics

Review article
Neurologic complications of radiation therapy

https://doi.org/10.1016/S0733-8619(02)00031-2Get rights and content

Section snippets

Epidemiology

The incidence of radiation-induced nervous system complications varies with the radiation dose, field size, and fractionation scheme; degree of edema; patient age; underlying diseases (malignant and nonmalignant); concomitant treatments; and length of survival after completion of radiation (Table 1). As a rule, incidence increases and latency decreases with higher total doses, higher fraction size, and larger volumes of treated nervous system [2].

Among the acute complications, acute radiation

Clinical characteristics

Radiation-related nervous system injury can affect every level of the nervous system and can occur acutely during the course of treatment or months or years after treatment has been completed. Different syndromes of nervous system injury have been characterized and can be classified anatomically or temporally (Table 2, Table 3). Because the same nervous system structures are susceptible to different radiation-related syndromes occurring at differing times after radiation therapy, a temporally

Differential diagnosis and approach to the patient

In general, the most frequent and most pressing diagnosis competing with radiation-related nervous system injury is recurrent tumor. For specific syndromes, however, other neurologic and non-neurologic conditions may complicate the differential (Table 6).

When new symptoms develop over days or weeks, are mild, or improve over the weekend break from radiation therapy, a presumptive diagnosis of acute radiation encephalopathy and an empirical increase of steroid dose are reasonable. Marked or

Treatment and prevention

No specific intervention for radiation-related fatigue beyond adequate rest and prudent scheduling of activities is generally necessary. When recent or rapid tapering of corticosteroids has taken place, a return to higher doses may be beneficial. Occasionally, stimulant medication (methylphenidate or modafinil) may be considered. Increasing doses of corticosteroids generally ameliorates the symptoms of acute radiation encephalopathy and may hasten improvement in some patients with early delayed

Summary

Injury to the central and peripheral nervous systems is an increasingly frequent consequence of standard radiation treatment protocols for tumors involving or adjacent to nervous system structures. Characteristic temporal, clinical, radiographic, and laboratory features distinguish a number of specific radiation injury syndromes, but meticulous and repeated evaluations over time are often required to establish a diagnosis. These syndromes vary with regard to prognosis and therapeutic options,

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