Emergent Radiotherapy for Leukemia-Induced Cranial Neuropathies Refractory to Intrathecal Therapy

Abstract

Neurologic symptoms from leukemic infiltration of the central nervous system are an oncologic emergency, and expeditious treatment is required to preserve function. We report the case of a 44-year-old patient with relapsed acute myeloid leukemia (AML) who developed sub-acute cranial neuropathies refractory to treatment with intrathecal (IT) chemotherapy. The patient was therefore treated with an emergent course of whole-brain radiotherapy, resulting in immediate improvement and subsequent resolution of cranial neuropathies. This case illustrates that while central nervous system involvement by AML is rare, radiotherapy remains an effective modality to avoid long-term morbidity in patients failing to respond to systemic or IT chemotherapy.

Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives

“…It is considered a medical emergency, as severe, irreversible vision loss can occur. 63 The recommended treatment is radiation therapy, 64 as systemic chemotherapy is not shown to be beneficial and intrathecal chemotherapy is not enough to eradicate leukemic cells in the paraneural space of the optic nerve. 62 …”

Central Nervous System Prophylaxis and Treatment in Acute Leukemias

“…Radiation can be considered in patients who need urgent palliation, although it must be noted that responses to systemic or intrathecal chemotherapy, or steroids, can be rapid as well. In the setting of palliation, focal RT can often be beneficial, particularly for patients who have been refractory to chemotherapy [41]. In a series of 163 patients, 2/3 of whom presented with cranial neuropathy, radiation was associated with resolution or improvement of deficits in almost 70% of patients.…”