Download PDF
Semin Neurol 2004; 24(4): 405-417
DOI: 10.1055/s-2004-861535
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Complications of Radiation Therapy on the Brain and Spinal Cord

Anthony Béhin1 , Jean-Yves Delattre1
  • 1Fédération de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
Further Information

Publication History

Publication Date:
07 January 2005 (online)

    Permissions and Reprints

ABSTRACT

Various nervous system complications can result from radiation therapy. Usually classified according to the timing of onset after irradiation, these complications can be debilitating and even life-threatening. A better knowledge of the risk factors has allowed the definition of “safe” procedures that have reduced the incidence of severe sequelae. This review addresses the main clinical, radiological, biological, and therapeutic issues pertaining to the side effects of radiation therapy on the brain and spinal cord, including radiation-induced vascular and endocrine complications.

KEYWORDS

Radiotherapy - encephalopathy - glioma - arteriopathy - dementia - cognitive impairment - endocrine dysfunction - myelopathy - radio-induced tumor

REFERENCES

  • 1 Young D F, Posner J B, Chu F, Nisce L. Rapid-course radiation therapy of cerebral metastases: results and complications.  Cancer. 1974;  34 1069-1076
    PubMedGoogle Scholar
  • 2 Hindo W A, DeTrana F A, Lee M S, Hendrickson F R. Large dose increment irradiation in treatment of cerebral metastases.  Cancer. 1970;  26 138-141
    PubMedGoogle Scholar
  • 3 Posner J B. Side effects of radiation therapy. In: Posner JB Neurologic Complications of Cancer. Philadelphia; FA Davis 1995: 311-337
    Google Scholar
  • 4 Keime-Guibert F, Napolitano M, Delattre J Y. Neurological complications of radiotherapy and chemotherapy.  J Neurol. 1998;  245 695-708
    PubMedGoogle Scholar
  • 5 Phillips P C, Delattre J Y, Berger C A, Rottenberg D A. Early and progressive increases in regional brain capillary permeability following single- and fractionated-dose cranial radiation in rat.  Neurology. 1987;  37 301 , (Abstract)
    PubMedGoogle Scholar
  • 6 Freeman J, Johnstone P, Voke J. Somnolence after prophylactic cranial irradiation in children with acute leukaemia.  BMJ. 1973;  290 523-525
    PubMedGoogle Scholar
  • 7 Littman P, Rosenstock J, Gale G et al.. The somnolence syndrome in leukemic children following reduced daily dose fractions of cranial radiation.  Int J Radiat Oncol Biol Phys. 1984;  10 1851-1853
    PubMedGoogle Scholar
  • 8 Ch'ien L T, Aur R J, Stagner S et al.. Long-term neurological implications of somnolence syndrome in children with acute lymphocytic leukemia.  Ann Neurol. 1980;  8 273-277
    CrossrefPubMedGoogle Scholar
  • 9 Faithfull S, Brada M. Somnolence syndrome in adults following cranial irradiation for primary brain tumours.  Clin Oncol (R Coll Radiol). 1998;  10 250-254
    CrossrefPubMedGoogle Scholar
  • 10 Mandell L, Walker W, Steinherz P, Fuks Z. Reduced incidence of the somnolence syndrome in leukemic children with steroid coverage during prophylactic cranial radiation therapy.  Cancer. 1989;  63 1975-1978
    CrossrefPubMedGoogle Scholar
  • 11 Armstrong C, Ruffer J, Corn B W, Devriees K, Mollman J. Biphasic patterns of memory deficits following moderate-dose partial-brain irradiation: neuropsychologic outcome and proposed mechanisms.  J Clin Oncol. 1995;  13 2263-2271
    PubMedGoogle Scholar
  • 12 Vigliani M C, Sichez N, Poisson M, Delattre J Y. A prospective study of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4 year results.  Int J Radiat Oncol Biol Phys. 1996;  35 527-533
    CrossrefPubMedGoogle Scholar
  • 13 Chak L Y, Zatz L M, Wasserstein P et al.. Neurological dysfunction in patients treated for small cell carcinoma of the lung: a clinical radiological study.  Int J Radiat Oncol Biol Phys. 1986;  12 385-389
    PubMedGoogle Scholar
  • 14 Créange A, Felten D, Kiesel I, Renard J L, Vespignani H, Béquet D. Leucoencéphalopathie subaiguë du rhombencéphale après radiothérapie hypophysaire.  Rev Neurol. 1994;  150 704-708
    PubMedGoogle Scholar
  • 15 Lampert P, Tom M I, Rider W D. Disseminated demyelination of the brain following Co60 radiation.  Arch Pathol. 1959;  68 322-330
    PubMedGoogle Scholar
  • 16 Malone S, Raaphorst G P, Gray R, Girard A, Alsbeih G. Enhanced in vitro radiosensitivity of skin fibroblasts in two patients developing brain necrosis following AVM radiosurgery: a new risk factor with potential for a predictive assay.  Int J Radiat Oncol Biol Phys. 2000;  47 185-189
    CrossrefPubMedGoogle Scholar
  • 17 Flickinger J C, Kondziolka D, Lunsford L D et al.. Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients: arteriovenous malformation study group.  Int J Radiat Oncol Biol Phys. 2000;  46 1143-1148
    CrossrefPubMedGoogle Scholar
  • 18 Schlienger M, Atlan D, Lefkopooulos D et al.. Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients.  Int J Radiat Oncol Biol Phys. 2000;  46 1135-1142
    CrossrefPubMedGoogle Scholar
  • 19 Miyawaki L, Dowd C, Wara W et al.. Five year results of LINAC radiosurgery for arteriovenous malformations: outcome for large AVMs.  Int J Radiat Oncol Biol Phys. 1999;  44 1089-1106
    CrossrefPubMedGoogle Scholar
  • 20 Delattre J Y, Posner J B. Neurological complications of chemotherapy and radiation therapy. In: Aminoff MJ Neurology and General Medicine. 2nd ed. New York; Churchill Livingstone 1995: 421-445
    Google Scholar
  • 21 Oppenheimer J H, Levy M L, Sinha U et al.. Radionecrosis secondary to interstitial brachytherapy: correlation of magnetic resonance magnetic imaging and histopathology.  Neurosurgery. 1992;  31 336-343
    PubMedGoogle Scholar
  • 22 Van Effenterre R, Boch A L. Radionécrose du chiasma.  Neurochirurgie. 1993;  39 75-84
    PubMedGoogle Scholar
  • 23 Coghlan K M, Magennis P. Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature.  Int J Oral Maxillofac Surg. 1999;  28 50-52
    CrossrefPubMedGoogle Scholar
  • 24 Kumar A J, Leeds N E, Fuller G N et al.. Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment.  Radiology. 2000;  217 377-384
    CrossrefPubMedGoogle Scholar
  • 25 Janus T J, Kim E E, Tilbury R, Bruner J M, Yung W K. Use of [18F]fluorodeoxyglucose positron emission tomography in patients with primary malignant brain tumors.  Ann Neurol. 1993;  33 540-548
    CrossrefPubMedGoogle Scholar
  • 26 Lamy-Lhuillier C, Dubois F, Blond S, Lecouffe P, Steinling M. Intérêt de la tomoscintigraphie cérébrale au sestamibi marqué au technétium dans le diagnostic différentiel récidive tumorale-radionécrose des tumeurs gliales sus-tentorielles de l'adulte.  Neurochirurgie. 1999;  45 110-117
    PubMedGoogle Scholar
  • 27 Ricci P E, Karis J P, Heiserman J E, Fram E K, Bice A N, Drayer B P. Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography.  AJNR Am J Neuroradiol. 1998;  19 407-413
    PubMedGoogle Scholar
  • 28 Matheja P, Rickert C, Weckesser M, Hoss N, Schober O. Scintigraphic pitfall: delayed radionecrosis. Case illustration.  J Neurosurg. 2000;  92 732
    PubMedGoogle Scholar
  • 29 Forsyth P A, Kelly P J, Cascino T L et al.. Radiation necrosis or glioma recurrence: is computer-assisted stereotactic biopsy useful?.  J Neurosurg. 1995;  82 436-444
    PubMedGoogle Scholar
  • 30 Glantz M J, Burger P C, Friedman A H, Radtke R A, Massey E W, Schold Jr S C. Treatment of radiation induced nervous system injury with heparin and warfarin.  Neurology. 1994;  44 2020-2027
    CrossrefPubMedGoogle Scholar
  • 31 Chuba P J, Aronin P, Bhambhani K et al.. Hyperbaric oxygen therapy for radiation-induced brain injury in children.  Cancer. 1997;  80 2005-2012
    CrossrefPubMedGoogle Scholar
  • 32 Leber K A, Eder H G, Kovac H, Anegg U, Pendl G. Treatment of cerebral radionecrosis by hyperbaric oxygen therapy.  Stereotact Funct Neurosurg. 1998;  70 229-236
    PubMedGoogle Scholar
  • 33 Kohshi K, Imada H, Nomoto S, Yamaguchi R, Abe H, Yamamoto H. Successful treatment of radiation-induced brain necrosis by hyperbaric oxygen treatment.  J Neurol Sci. 2003;  209 115-117
    CrossrefPubMedGoogle Scholar
  • 34 Chan A S, Cheung M C, Law S C, Chan J H. Phase II study of alpha-tocopherol in improving the cognitive function of patients with temporal lobe radionecrosis.  Cancer. 2004;  100 398-404
    CrossrefPubMedGoogle Scholar
  • 35 Tofilon P J, Fike J R. The radioresponse of the central nervous system: a dynamic process.  Radiat Res. 2000;  153 357-370
    PubMedGoogle Scholar
  • 36 Schultheiss T E, Stephens L C. Permanent radiation myelopathy.  Br J Radiol. 1992;  65 737-753
    PubMedGoogle Scholar
  • 37 Calvo W, Hopewell J W, Reinhold H S, Yeung T K. Time- and dose-related changes in the white matter of the rat brain after single doses of X-rays.  Br J Radiol. 1988;  61 1043-1052
    PubMedGoogle Scholar
  • 38 Reinhold H S, Calvo W, Hopewell J W, Van der Berg A P. Development of blood vessel-related radiation damage in the fimbria of the central nervous system.  Int J Radiat Oncol Biol Phys. 1990;  18 37-42
    PubMedGoogle Scholar
  • 39 Delattre J Y, Rosenblum L K, Thaler H R, Mandell L, Shapiro W R, Posner J B. A model of radiation myelopathy in the rat.  Brain. 1988;  111 1319-1336
    PubMedGoogle Scholar
  • 40 Morris G M, Coderre J A, Micca P L, Fisher C, Capala J, Hopewell J A. Central nervous system tolerance to boron neutron capture therapy with p-boronophenylalanine.  Br J Cancer. 1997;  76 1623-1629
    PubMedGoogle Scholar
  • 41 Van der Maazen R WM, Berhagen I, Kleiboer B J, van der Kogel A J. Radiosensitivity of glial progenitor cells of the perinatal and adult rat optic nerve studied by an in vitro clonogenic assay.  Radiother Oncol. 1991;  20 258-264
    PubMedGoogle Scholar
  • 42 Van der Maazen R WM, Kleiboer B J, Berhagen I, van der Kogel A J. Irradiation in vitro discriminates between different O-2A progenitor cell subpopulations in the perinatal central nervous system of rats.  Radiat Res. 1991;  128 64-72
    PubMedGoogle Scholar
  • 43 Van der Maazen R WM, Kleiboer B J, Berhagen I, van der Kogel A J. Repair capacity of adult rat glial progenitor cells determined by an in vitro clonogenic assay after in vitro or in vivo fractionated irradiation.  Int J Radiat Biol. 1993;  63 661-666
    PubMedGoogle Scholar
  • 44 Hornsey S, Myers R, Coultas P G, Rogers M A, White A. Turnover of proliferative cells in the spinal cord after x irradiation and its relation to time-dependent repair of radiation damage.  Br J Radiol. 1981;  54 1081-1085
    PubMedGoogle Scholar
  • 45 Asai A, Matsutani M, Kohno T et al.. Subacute brain atrophy after radiation therapy for malignant brain tumor.  Cancer. 1989;  63 1962-1974
    PubMedGoogle Scholar
  • 46 Enokido Y, Araki T, Tanaka K, Aizawa S, Hatanaka H. Involvement of p53 in DNA strand break-induced apoptosis in postmitotic CNS neurons.  Eur J Neurosci. 1996;  8 1812-1821
    PubMedGoogle Scholar
  • 47 Gobbel G T, Bellinzona M, Vogt A R, Gupta N, Fike J R, Cha P H. Response of postmitotic neurons to X-irradiation: implications for the role of DNA damage in neuronal apoptosis.  J Neurosci. 1998;  18 147-155
    PubMedGoogle Scholar
  • 48 Noel F, Tofilon P J. Astrocytes protect against x-ray-induced neuronal toxicity in vitro.  Neuroreport. 1998;  9 1133-1137
    PubMedGoogle Scholar
  • 49 Montgomery D L. Astrocytes: form, function and roles in disease.  Vet Pathol. 1994;  31 145-167
    PubMedGoogle Scholar
  • 50 Muller H W, Junghans U, Kappler J. Astroglial neurotrophic and neurite-promoting factors.  Pharmacol Ther. 1995;  65 1-18
    CrossrefPubMedGoogle Scholar
  • 51 Ridet J L, Malhotra S K. Reactive astrocytes: cellular and molecular clues to biological function.  Trends Neurosci. 1997;  20 570-577
    CrossrefPubMedGoogle Scholar
  • 52 Chiang C S, McBride W H, Withers H R. Radiation-induced astrocytic and microglial responses in mouse brain.  Radiother Oncol. 1993;  29 60-68
    CrossrefPubMedGoogle Scholar
  • 53 Barres B A, Raff M C. Proliferation of oligodendrocyte precursor cells depends on electrical activity in axons.  Nature. 1993;  361 258-260
    CrossrefPubMedGoogle Scholar
  • 54 Wilson J X. Antioxidant defense of the brain: a role for astrocytes.  Can J Physiol Pharmacol. 1997;  75 1149-1163
    CrossrefPubMedGoogle Scholar
  • 55 Schroeter M L, Mertsch K, Giese H et al.. Astrocytes enhance radical defence in capillary endothelial cells constituting the blood-brain barrier.  FEBS Lett. 1999;  449 241-244
    CrossrefPubMedGoogle Scholar
  • 56 Iwata-Ichikawa E, Kondo Y, Miyazaki I, Asanuma M, Ogawa N. Glial cells protect neurons against oxidative stress via transcriptional up-regulation of the glutathione synthesis.  J Neurochem. 1999;  72 2334-2344
    CrossrefPubMedGoogle Scholar
  • 57 Desagher S, Glowinski J, Premont J. Astrocytes protect neurons form hydrogen peroxyde toxicity.  J Neurosci. 1996;  16 2553-2562
    CrossrefPubMedGoogle Scholar
  • 58 Janzer R C, Raff M C. Astrocytes induce blood-brain barrier properties in endothelial cells.  Nature. 1987;  325 253-257
    CrossrefPubMedGoogle Scholar
  • 59 Nakagawa M, Bellinzona M, Seilhan T M, Gobbel G T, Lamborn K R, Fike J R. Microglial responses after focal radiation-induced injury are affected by alpha-difluoromethylornithine.  Int J Radiat Oncol Biol Phys. 1996;  36 113-123
    PubMedGoogle Scholar
  • 60 Zucker-Franklin D, Warfel A, Grusky G, Frangione B, Teitel D. Novel monocyte-like properties of microglial/astroglial cells. Constitutive secretion of lysozyme and cystatin-C.  Lab Invest. 1987;  57 176-185
    PubMedGoogle Scholar
  • 61 Thomas W E. Brain macrophages: evaluation of microglia and their function.  Brain Res Brain Res Rev. 1992;  17 61-74
    CrossrefPubMedGoogle Scholar
  • 62 Hopewell J W, Cavanagh J B. Effects of X irradiation on the mitotic activity of the subependymal plate of rats.  Br J Radiol. 1972;  45 461-465
    PubMedGoogle Scholar
  • 63 Tada E, Yang E, Gobbel G T, Lamborn K R, Fike J R. Long-term impairment of subependymal repopulation following damage by ionizing irradiation.  Exp Neurol. 1999;  160 66-77
    CrossrefPubMedGoogle Scholar
  • 64 Imperato J P, Paleologos N A, Vick N A. Effects of treatment on long-term survivors with malignant gliomas.  Ann Neurol. 1990;  28 818-822
    CrossrefPubMedGoogle Scholar
  • 65 Vigliani M C, Duyckaerts C, Delattre J Y. Radiation-induced cognitive dysfunction in adults. In: Vecht CJ Handbook of Clinical Neurology. Vol. 23. Amsterdam; Elsevier Science 1997: 371-388
    Google Scholar
  • 66 Archibald Y M, Lunn D, Ruttan L A et al.. Cognitive functioning in long-term survivors of high-grade glioma.  J Neurosurg. 1994;  80 247-253
    PubMedGoogle Scholar
  • 67 Lee P WH, Hung B KM, Woo E KW, Tai P TH, Choi D TK. Effects of radiation therapy on neuropsychological functioning in patients with nasopharyngeal carcinoma.  J Neurol Neurosurg Psychiatry. 1989;  52 488-492
    PubMedGoogle Scholar
  • 68 DeAngelis L M, Delattre J Y, Posner J B. Radiation-induced dementia in patients cured of brain metastases.  Neurology. 1989;  39 789-796
    PubMedGoogle Scholar
  • 69 Siegal T, Lossos A, Pfeffer M R. Leptomeningeal metastases: analysis of 31 patients with sustained off-therapy response following combined-modality therapy.  Neurology. 1994;  44 1463-1469
    PubMedGoogle Scholar
  • 70 DeAngelis L M, Yahalom J, Thaler H T, Kher U. Combined modality therapy for primary CNS lymphoma.  J Clin Oncol. 1992;  10 635-643
    PubMedGoogle Scholar
  • 71 Abrey L E, Yahalom J, DeAngelis L M. Treatment for primary CNS lymphoma: the next step.  J Clin Oncol. 2000;  18 3144-3150
    PubMedGoogle Scholar
  • 72 Taphoorn M J, Klein M. Cognitive deficits in adult patients with brain tumours.  Lancet Neurol. 2004;  3 159-168
    PubMedGoogle Scholar
  • 73 Klein M, Engelberts N H, van der Ploeg H M et al.. Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life.  Ann Neurol. 2003;  54 514-520
    CrossrefPubMedGoogle Scholar
  • 74 Klein M, Heimans J J, Aaronson N K et al.. Effect of radiotherapy and other treatment-related factors on mid-term and long-term cognitive sequelae in low-grade gliomas: a comparative study.  Lancet. 2002;  360 1361-1368
    CrossrefPubMedGoogle Scholar
  • 75 Armstrong C L, Hunter J V, Ledakis G E et al.. Late cognitive and radiographic changes related to radiotherapy. Initial prospective findings.  Neurology. 2002;  59 40-48
    CrossrefPubMedGoogle Scholar
  • 76 Torres I J, Mundt A J, Sweeney P J et al.. A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors.  Neurology. 2003;  60 1113-1118
    PubMedGoogle Scholar
  • 77 Armstrong C L, Corn B W, Ruffer J E, Pruitt A A, Mollman J E, Phillips P C. Radiotherapeutic effects on brain function: double dissociation of memory systems.  Neuropsychiatry Neuropsychol Behav Neurol. 2000;  13 101-111
    PubMedGoogle Scholar
  • 78 Postma T J, Klein M, Verstappen C C et al.. Radiotherapy-induced cerebral abnormalities in patients with low-grade gliomas.  Neurology. 2002;  59 121-123
    PubMedGoogle Scholar
  • 79 Meyers C A, Weitzner M A, Valentine A D, Levin V A. Methylphenidate therapy improves cognition, mood, and function of brain tumor patients.  J Clin Oncol. 1998;  16 2522-2527
    PubMedGoogle Scholar
  • 80 Crossen J R, Garwood D, Glatstein E, Neuwelt E A. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy.  J Clin Oncol. 1994;  12 627-642
    PubMedGoogle Scholar
  • 81 Brown P D, Buckner J C, O'Fallon J R et al.. Effects on radiotherapy on cognitive function in patients with low-grade glioma measured by the Folstein MMSE.  J Clin Oncol. 2003;  21 2519-2524
    CrossrefPubMedGoogle Scholar
  • 82 Thiessen B, DeAngelis L M. Hydrocephalus in radiation leukoencephalopathy.  Arch Neurol. 1998;  55 705-710
    CrossrefPubMedGoogle Scholar
  • 83 Perrini P, Scollato A, Cioffi F, Mouchaty H, Conti R, Di Lorenzo N. Radiation leukoencephalopathy associated with moderate hydrocephalus: intracranial pressure monitoring and results of ventriculoperitoneal shunting.  Neurol Sci. 2002;  23 237-241
    CrossrefPubMedGoogle Scholar
  • 84 Ron E, Modan B, Boice J D et al.. Tumors of the brain and nervous system after radiotherapy in childhood.  N Engl J Med. 1988;  319 1033-1039
    CrossrefPubMedGoogle Scholar
  • 85 Hawkins M M, Draper G J, Kingston J E. Incidence of second primary tumors among childhood cancer survivors.  Br J Cancer. 1987;  56 339-347
    PubMedGoogle Scholar
  • 86 Brada M, Ford D, Ashley S et al.. Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenomas.  BMJ. 1992;  304 1343-1346
    PubMedGoogle Scholar
  • 87 Neglia J P, Meadows A T, Robison L L et al.. Second neoplasms after acute lymphoblastic leukemia in childhood.  N Engl J Med. 1991;  325 1330-1336
    PubMedGoogle Scholar
  • 88 Amirjamshidi A, Abbassioun K. Radiation-induced tumors of the central nervous system occurring in childhood and adolescence. Four unusual lesions in three patients and a review of the literature.  Childs Nerv Syst. 2000;  16 390-397
    CrossrefPubMedGoogle Scholar
  • 89 Strojan P, Popovic M, Jereb B. Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature.  Int J Radiat Oncol Biol Phys. 2000;  48 65-73
    CrossrefPubMedGoogle Scholar
  • 90 Musa B S, Pople I K, Cummins B H. Intracranial meningiomas following irradiation-a growing problem?.  Br J Neurosurg. 1995;  9 629-637
    CrossrefPubMedGoogle Scholar
  • 91 Mack E E. Radiation-induced tumors. In: Berger MS, Wilson CB The Gliomas. Philadelphia; WB Saunders 1999: 724-735
    Google Scholar
  • 92 Murros K E, Toole J F. The effect of radiation on the carotid artery.  Arch Neurol. 1989;  46 445-449
    PubMedGoogle Scholar
  • 93 Gupta S. Radiation induced carotid artery blow out: a case report.  Acta Chir Belg. 1994;  94 299-300
    PubMedGoogle Scholar
  • 94 McCready R A, Hyde G P, Bivins B A. Radiation induced arterial injuries.  Surgery. 1983;  93 306-312
    PubMedGoogle Scholar
  • 95 Bernstein M, Lumley M, Davidson G, Laperriere N, Leung P. Intracranial arterial occlusion associated with high-activity iodine-125 brachytherapy for glioblastoma.  J Neurooncol. 1993;  17 253-260
    CrossrefPubMedGoogle Scholar
  • 96 Werner M H, Burger P C, Heinz E R, Friedman A H, Halperin E C, Schold Jr S C. Intracranial atherosclerosis following radiotherapy.  Neurology. 1988;  38 1158-1160
    PubMedGoogle Scholar
  • 97 Grill J, Couanet D, Cappelli C et al.. Radiation-induced cerebral vasculopathy in children with neurofibromatosis and optic pathway glioma.  Ann Neurol. 1999;  45 393-396
    CrossrefPubMedGoogle Scholar
  • 98 Bitzer M, Topka H. Progressive cerebral occlusive disease after radiation therapy.  Stroke. 1995;  26 131-136
    PubMedGoogle Scholar
  • 99 Suzuki Y, Negoro M, Shibuya M, Yoshida J, Negoro T, Watanabe K. Surgical treatment for pediatric moyamoya disease: use of the superficial temporal artery for both areas supplied by the anterior and middle cerebral arteries.  Neurosurgery. 1997;  40 324-329
    CrossrefPubMedGoogle Scholar
  • 100 Dauser R C, Tuite G F, McCluggage C W. Dural inversion procedure for moyamoya disease. Technical note.  J Neurosurg. 1997;  86 719-723
    PubMedGoogle Scholar
  • 101 Fouladi M, Langston J, Mulhern R et al.. Silent lacunar lesions detected by MRI of children with brain tumors: a late sequela of therapy.  J Clin Oncol. 2000;  18 824-831
    PubMedGoogle Scholar
  • 102 Novelli P M, Reigel D H, Langham Gleason P, Yunis E. Multiple cavernous angiomas after high-dose whole-brain radiation therapy.  Pediatr Neurosurg. 1997;  26 322-325
    PubMedGoogle Scholar
  • 103 Jensen F K, Wagner A. Intracranial aneurysm following radiation therapy for medulloblastoma. A case report and review of the literature.  Acta Radiol. 1997;  38 37-42
    PubMedGoogle Scholar
  • 104 Azzarelli B, Moore J, Gilmor R, Muller J, Edwarrds M, Mealey J. Multiple fusiform intracranial aneurysms following curative radiation therapy for suprasellar germinoma.  J Neurosurg. 1984;  61 1141-1145
    CrossrefPubMedGoogle Scholar
  • 105 Constine L S, Woolf P D, Cann D et al.. Hypothalamic-pituitary dysfunction after radiation for brain tumors.  N Engl J Med. 1993;  328 87-94
    CrossrefPubMedGoogle Scholar
  • 106 Littley M D, Shalet S M, Beardwell C G. Radiation and hypothalamic-pituitary function.  Baillieres Clin Endocrinol Metab. 1990;  4 147-175
    CrossrefPubMedGoogle Scholar
  • 107 Littley M D, Shalet S M, Beardwell C G, Robinson E L, Sutton M L. Radiation-induced hypopituitarism is dose-dependent.  Clin Endocrinol (Oxf). 1989;  31 363-375
    PubMedGoogle Scholar
  • 108 Clayton P E, Shalet S M. Dose dependency of time of onset of radiation-induced growth hormone deficiency.  J Pediatr. 1991;  118 226-228
    PubMedGoogle Scholar
  • 109 Rappaport R, Brauner R. Growth and endocrine disorders secondary to cranial irradiation.  Pediatr Res. 1989;  25 561-567
    PubMedGoogle Scholar
  • 110 Schmiegelow M, Lassen S, Poulsen S et al.. Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study.  Clin Endocrinol (Oxf). 2000;  53 191-197
    CrossrefPubMedGoogle Scholar
  • 111 Arlt W, Hove U, Müller B et al.. Frequent and frequently overlooked: treatment-induced endocrine dysfunction in adult long-term survivors of primary brain tumors.  Neurology. 1997;  49 498-506
    CrossrefPubMedGoogle Scholar
  • 112 Taphoorn M JB, Heimans J J, Van der Veen E A, Karim A B MF. Endocrine functions in long-term survivors of low-grade supratentorial glioma treated with radiation therapy.  J Neurooncol. 1995;  25 97-102
    CrossrefPubMedGoogle Scholar
  • 113 Samaan N A, Vieto R, Schultz P N, Mao R M, Meoz R T, Sampiere V A. Hypothalamic pituitary and thyroid dysfunction after radiotherapy of the head and neck.  Int J Radiat Oncol Biol Phys. 1982;  8 1857-1867
    CrossrefPubMedGoogle Scholar
  • 114 Petterson T, MacFarlane I A, Foy P M, Hughes H J, Jones B, Shaw D. Hyperprolactinaemia and infertility following cranial irradiation for brain tumours: successful treatment with bromocriptine.  Br J Neurosurg. 1993;  7 571-574
    PubMedGoogle Scholar
  • 115 Ahlbom H. Results of radiotherapy of hypopharyngeal cancer at Radium-Hemmet, Stockholm.  Acta Radiol. 1941;  22 155-171
    PubMedGoogle Scholar
  • 116 Rampling R, Symonds P. Radiation myelopathy.  Curr Opin Neurol. 1998;  11 627-632
    PubMedGoogle Scholar
  • 117 Word J A, Kalokhe U P, Aron B S. Transient radiation myelopathy in patients with Hodgkin's disease treated by mantle irradiation.  Int J Radiat Oncol Biol Phys. 1980;  6 1731-1733
    PubMedGoogle Scholar
  • 118 Fein D A, Marcus R B, Parsons J T, Mendenhall W M, Million R R. Lhermitte's sign incidence and treatment variables influencing risk after irradiation of the cervical spinal cord.  Int J Radiat Oncol Biol Phys. 1993;  27 1029-1033
    PubMedGoogle Scholar
  • 119 Esik O, Csere T, Stefanits K et al.. A review on radiogenic Lhermitte's sign.  Pathol Oncol Res. 2003;  9 115-120
    PubMedGoogle Scholar
  • 120 Lewanski C R, Sinclair J A, Stewart J S. Lhermitte's sign following head and neck radiotherapy.  Clin Oncol (R Coll Radiol). 2000;  12 98-103
    PubMedGoogle Scholar
  • 121 Peterson K, Rosenblum M K, Powers J M, Alvord E, Walker R W, Posner J B. Effect of brain irradiation on demyelinating lesions.  Neurology. 1993;  43 2105-2112
    PubMedGoogle Scholar
  • 122 Li Y Q, Jay V, Wong C. Oligodendrocytes in the adult rat spinal cord undergo radiation induced apoptosis.  Cancer Res. 1996;  56 5417-5422
    PubMedGoogle Scholar
  • 123 Schultheiss T E, Kun L E, Ang K K, Stephens L C. Radiation response of the central nervous system.  Int J Radiat Oncol Biol Phys. 1995;  31 1093-1112
    CrossrefPubMedGoogle Scholar
  • 124 Chao M W, Wirth A, Ryan G, MacManus M, Liew K H. Radiation myelopathy following transplantation and radiotherapy for non-Hodgkin's lymphoma.  Int J Radiat Oncol Biol Phys. 1998;  41 1057-1061
    CrossrefPubMedGoogle Scholar
  • 125 Pallis C A, Louis S, Morgan R L. Radiation myelopathy.  Brain. 1961;  84 460-479
    PubMedGoogle Scholar
  • 126 Wang P Y, Shen W C, Jan J S. MR imaging in radiation myelopathy.  AJNR Am J Neuroradiol. 1992;  13 1049-1055
    PubMedGoogle Scholar
  • 127 Yasui T, Yagura H, Komiyama M et al.. Significance of gadolinium enhanced MRI in differentiating spinal cord radiation myelopathy from tumor.  J Neurosurg. 1992;  77 628-631
    PubMedGoogle Scholar
  • 128 Wang P J, Shen W C, Jan J S. Serial MRI changes in radiation myelopathy.  Neuroradiology. 1995;  37 374-377
    PubMedGoogle Scholar
  • 129 Komachi H, Tsuchiya K, Ikeda M, Koike R, Matsunaga T, Ikeda K. Radiation myelopathy: a clinicopathological study with special reference to correlation between MRI findings and neuropathology.  J Neurol Sci. 1995;  132 228-232
    CrossrefPubMedGoogle Scholar
  • 130 Koehler P J, Verbiest H, Jager J, Vecht C J. Delayed radiation myelopathy: serial MR-imaging and pathology.  Clin Neurol Neurosurg. 1996;  98 197-201
    CrossrefPubMedGoogle Scholar
  • 131 Michikawa M, Wada Y, Sano M et al.. Radiation myelopathy: significance of gadolinium-DTPA enhancement in the diagnosis.  Neuroradiology. 1991;  33 286-289
    CrossrefPubMedGoogle Scholar
  • 132 Alfonso E R, De Gregorio M A, Mateo P et al.. Radiation myelopathy in over-irradiated patients: MR imaging findings.  Eur Radiol. 1997;  7 400-404
    CrossrefPubMedGoogle Scholar
  • 133 Angibaud G, Ducasse J L, Baille G, Clanet M. Potential value of hyperbaric oxygen in the treatment of post radiation myelopathies.  Rev Neurol. 1995;  151 661-666
    PubMedGoogle Scholar
  • 134 Calabro F, Jinkins J R. MRI of radiation myelitis: a report of a case treated with hyperbaric oxygen.  Eur Radiol. 2000;  10 1079-1084
    CrossrefPubMedGoogle Scholar
  • 135 Allen J C, Miller D C, Budzilovitch G N, Epstein F J. Brain and spinal cord hemorrhage in long-term survivors of malignant pediatric brain tumors: a possible late effect of therapy.  Neurology. 1991;  41 148-150
    PubMedGoogle Scholar

Anthony BéhinM.D. 

Fédération de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière

47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France