Radiation myelopathy in children

Abstract

Three children, 1 with medulloblastoma, 1 with anaplastic cerebellar tumor, and 1 with acute lymphocytic leukemia, received craniospinal irradiation with an estimated cord dose between 1,100 and 1,200 rets. All 3 patients after a latent period of seven to eight months developed subacute transverse myelopathy. The myelopathy was cervical in 2 patients and thoracic in 1. Spinal fluid examination showed high protein levels in 2 patients. Myelography demonstrated a swollen cord in 2 patients and normal appearance in 1. Autopsy in 1 patient disclosed a necrotizing myelopathy. The findings suggest that children tolerate less well than adults what previously have been considered safe doses of radiation to the spinal cord.

Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children

“…Stein [97] also did not recommend radiotherapy for adult patients with low-grade intramedullary neoplasms regardless of the extent of removal, and emphasized the deleterious effects of radiation on the spinal cord tissue adjacent to the tumor site. The results are similar to those of others who have reported myelopathy in children treated with doses of 30 Gy [98]. Therefore, radiation therapy should be reserved for patients with malignant tumors, patients with inoperable tumor recurrence, or for those with substantial residual tumor for whom further surgery is considered too risky.…”

Treatment of spinal cord tumors in children

“…Radiation myelopathy can either be transient or a progressive process leading to complete transverse myelopathy [13,21]. Our experience to date suggests that a dose of 40Gy for low-grade tumors is sufficient, but longer follow-up of our patients is needed before definitive conclusions can be reached.…”

Radiation Injury to the Central Nervous System: Clinical Features and Prevention

“…A realistic estimate of the ED 5 (5% complications) for 2-Gy fractions is between 57 and 61 Gy. There is no firm clinical data to support the general belief that the radiation tolerance of the spinal cord in children is much lower than that in adults, as only very few cases of childhood radiation myelopathy have been reported [11]. However, those few cases were observed after doses of about 40 Gy delivered in =2 Gy/fraction.…”

“…Clinical data suggest that the radiation tolerance of the spinal cord of children may be lower than that of adults, as the few cases of childhood myelopathy were observed after doses of about 40 Gy delivered in =2 Gy/ fraction [11]. Ruifrok et al [20] addressed this issue in rodents.…”