Short-Course Radiation Therapy in Carcinoma of the Lung

Pathology of radiation myelopathy

“…The first cases of radionecrosis in the brain and the spinal cord were reported by Fisher and Holfelder in 1930 1 and Ahlbom in 1941 2 . Radiation myelopathy has received much attention as one of the most distressing complications of radiotherapy, 3–10 because the lateral and anterior funiculus, where pyramidal tracts and sensory fibers for temperature and pain are located, is often involved, and paraplegia or paranalgesia result 3,9,11 . Most cases of clinically reported radiation myelopathy occurred when the cervical or thoracic spinal cord was included in the radiation field by mistake during the radiotherapy of carcinoma of the lung, 5,6,10,11 esophagus, 9,10 or other head and neck tumors 2,3,10 .…”

Radiation Therapy in the Management of Carcinoma of the Lung

“…In their initial report Abramson and Cavanaugh described a higher survival rate (43 percent at 1 year) in a group of patients receiving 4000 rads with a split course, compared with a nonrandomized control group treated with 6000 rads for 6 weeks, 5 weekly fractions (14 percent survival at 1 year). 1 However, subsequent analysis of the data shows appreciably lower long-term survival rates in the split course group (13 percent at two years and 6.7 percent at three and four years). 2…”

“…This can be given with split courses. 1,18 Metastatic sites can be treated with doses of 3000 or 4000 rads delivered in 2 or 3 weeks.…”

Brain necrosis after fractionated radiation therapy: Is the halftime for repair longer than we thought?

“…Spinal cord myelopathy is another late side effect of radiation in the central nervous system that can have dire consequences, including paralysis. The dose response data available has been investigated in detail by Schultheiss, 10 and reviewed by Kirkpatrick et al 11 Disease sites considered include mostly lung, [12][13][14][15][16][17][18][19][20][21][22][23] but also head and neck [24][25][26] and breast. 27 Different dose response relationships were found when considering cervical versus thoracic spinal cord myelopathy, though there is some controversy on this topic.…”