Brain 1996 Oct;119 ( Pt 5):1429-39 
<b>The post-irradiation lower motor neuron syndrome neuronopathy or radiculopathy?</b> 
Bowen J, Gregory R, Squier M, Donaghy M. Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK. 
It is not known whether the post-irradiation <b>lower motor neuron syndrome</b> results from radiation damage to motor neuron cell bodies or from damage to the nerve roots of the cauda equina. ... The first reported neuropathological study... was performed in one patient who died. This showed a <b>radiation-induced vasculopathy of the proximal spinal roots, with preservation of motor neuronal cell bodies and spinal cord architecture. These clinical, radiological, neurophysiological and pathological findings all point to a predominantly, but not exclusively, motor radiculopathy affecting the irradiated portion of the cauda equina proximal to the dorsal root ganglia. Radiation exposure exceeded 40 Gy both in our series and in previous reports. The natural history of this disorder is one of relentless deterioration occasionally punctuated by 1-2-year periods of stability. Post-irradiation lumbosacral radiculopathy is a more accurate name for this condition.</b> 
&&url PMID: 8931568 


Int J Radiat Oncol Biol Phys 1994 Oct 15;30(3):575-81 Comment in: Int J Radiat Oncol Biol Phys. 1995 May 15;32(2):554 
<b>Radiation myelopathy following single courses of radiotherapy and retreatment.</b> 
Wong CS, Van Dyk J, Milosevic M, Laperriere NJ. Department of Radiation Oncology, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, Canada. 

...To assess the latent time, survival and dose-fractionation factors associated with permanent radiation myelopathy following single and multiple courses of radiotherapy to the spinal cord. ...: A retrospective analysis was undertaken .... Twenty-four patients developed permanent myelopathy after one course of radiation therapy and 11 patients following retreatment. Seven patients had histological confirmation of radiation myelopathy at autopsy. ... <b>The actuarial survival was 14% at 5 years (median: 8.3 months) from the date of diagnosis of radiation myelopathy.</b> Latent times for myelopathy following a single course of treatment (mean: 18.5 months, 7-57 months), were significantly longer than those after reirradiation (mean: 11.4 months, 4-25 months), p = 0.03. There was not a single incident of myelopathy in patients who received fractionated radiotherapy given once daily to an extrapolated response dose (ERD) of < or = 100 Gy2 (equivalent to 50 Gy in 25 daily fractions). Four patients who developed myelopathy after an ERD of < 100 Gy2 were all treated on accelerated fractionation protocols with multiple fractions given per day. Patients who were reirradiated received significantly higher doses (mean ERD of 148 Gy2) than those who had a single course of treatment (mean ERD of 121 Gy2), p = 0.001. ... <b>We conclude that the risk of radiation myelopathy following conventionally fractionated radiotherapy to the spinal cord is extremely small; giving multiple fractions per day reduces the spinal cord tolerance; latent time to myelopathy decreases following retreatment; and there is possible long-term recovery of radiation damage in the human spinal cord.</b> 
&&url PMID: 7928488 


Strahlenther Onkol 1993 Sep;169(9):543-4 
<b>[Radiation-induced myelitis following accelerated radiotherapy].</b> [Article in German] 
Dunst J, Dunst U, Wittmoser W. Strahlentherapeutische Klinik, Universitat Erlangen-Nurnberg. 
<b>We report a case of suspected radiation-induced myelitis after twice-daily irradiation with a cord dose of 45.8 Gy.</b> The 48-year old patient had been irradiated with two daily fractions of 1.8 Gy up to 70.2 Gy for oropharyngeal cancer T4 N2 G3 M0 and achieved a complete remission. The spinal cord received 42 Gy by open fields plus 3.8 Gy scatter irradiation after field reduction. Six months after radiotherapy clinical signs of tetraparesis occurred with two lesions in the cervical cord on MR-images. A complete neurological diagnostic procedure revealed no other causes than suspected radiation damage. This is the only case of radiation myelitis among 90 patients treated twice daily and over 2000 patients irradiated with conventional fractionation in the same technique and doses. 
&&url PMID: 8211674 


Cancer 1991 Nov 15;68(10):2138-41 
<b>Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater.</b> 
Jeremic B, Djuric L, Mijatovic L. Department of Oncology, University Hospital of Kragujevac, Yugoslavia. 
The incidence of permanent damage to the spinal cord as a complication of radiation therapy generally correlates positively with total radiation dose. .... The results of this study suggest that radiation damage to the cervical spinal cord correlates not only with total radiation dose, but also with fraction size. Low fraction sizes appear to decrease the incidence of such damage. 
&&url PMID: 1913452 


Radiother Oncol 1990 Mar;17(3):209-18 
<b>Neurological damage in patients irradiated twice on the spinal cord: a morphologic and electrophysiological study.</b> 
Magrini SM, Biti GP, de Scisciolo G, Bartelli M, Pinto F, Caramella D, Villari N. Hospital Department of Radiotherapy, University Department of Radiotherapy, Florence, Italy. 
We reviewed the files of 950 patients treated for Hodgkin's disease since 1966 and were able to find five patients treated with radiochemotherapy and irradiated twice on volumes including a cord segment, at various time intervals, and surviving until now. Seven patients with comparable clinical and therapeutic features, but not reirradiated on the cord, were chosen as a control group and were examined with the same diagnostic procedures. The cumulative cord dose in the reirradiated patients was recalculated and ranged from 50 to 70 Gy. All these patients and the control cases were followed up for more than 10 years and presented no or only minor neurological symptoms. We compare the results of both magnetic resonance imaging (MRI) and electrophysiological studies (spinal and scalp recorded somatosensory evoked potentials--SEPs) in an attempt to define the characteristics of the subclinical damage present in these patients. While no cord abnormality was demonstrated with MRI, electrophysiological studies evidenced a clear difference between cases and controls, as far as the D10-P1 conduction time and SEPs average amplitude are concerned. <b>Advantages and drawbacks of a wider use of electrophysiological methods in research work on cord radiation damage are presented, along with the possible implications of the results obtained for the understanding of the pathogenesis and of the dose dependence of radiation myelitis (RM).</b> 
&&url PMID: 2320750 


Clin Neuropathol 1988 May-Jun;7(3):134-8 
<b>Late nervous system disorders in cured malignant lymphoma: a clinical and neuropathological study.</b> 
Vesterby A, Reske-Nielsen E, Kristensen IB, Jastrup B, Thorling K. Department of Neuropathology, Aarhus Kommunehospital, University of Aarhus, Denmark. 
A 53-year-old woman was treated for and cured of low grade malignant lymphoma, localized to the neck, by irradiation and chemotherapy. One year later she developed signs of damage to the spinal cord with slight paraparesis of the lower extremities, which remained stationary for seven years. Then, new and rapidly progressive central and peripheral neurological symptoms developed. About one year later the patient died. At autopsy a malignant glioma of the right temporal lobe and radiation damage to the spinal cord were found. Lymphocytic infiltrations in the peripheral nerves and muscles of the lower extremities were also seen. A severe neurogenic atrophy was present but no relapse of malignant lymphoma was found. Depressed immune defense is suggested to be the cause of the pathological changes of the nervous system in this case. The inflammation of the peripheral nerves might be due to activation of a latent virus infection. 
&&url PMID: 3203483 


Cancer 1981 Oct 1;48(7):1680-3 
<b>Intramedullary tumor metastasis simulating radiation myelitis: report of a case.</b> 
Margolis L, Smith ME, Fortuin FD, Chin FK, Liebel SA, Hill DR.
A case of suspected radiation myelitis based on clinical history, previous irradiation, neurologic deficit in the irradiated volume, and normal myelogram is reported. At autopsy, intramedullary metastatic disease was found, but not radiation damage. All radiation details must be considered before making the diagnosis of radiation myelitis with confidence. It is important not to exclude other potentially helpful treatment, such as surgery or chemotherapy, by the presumptive diagnosis of radiation myelitis. 
&&url PMID: 7284968 


Psychiatr Neurol Med Psychol (Leipz) 1980 Nov;32(11):663-8 
<b>[Radiation myelopathy following radiotherapy of larynx cancer].</b> [Article in German] 
Buchholz A, Dahn I. 
On the basis of a case of radiation myelopathy after irradiation of a larynx carcinoma, the morphological characteristics and the clinical phenomena are demonstrated. In spite of constant improvement of the radiation therapy, the occurrence of a radiation damage of the central nervous system must be expected and included in the differential-diagnostic considerations. 
&&url PMID: 7208709