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Mechanisms and Modification of the Radiation Response of the Central Nervous System

  • Chapter
Modification of Radiation Response

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

  • 144 Accesses

Abstract

Radiobiological advances and technical developments have contributed significantly to reduce the risk of radiation-induced central nervous system damage. In some instances, utilization of both fractionation parameters and methods to decrease the irradiated volume of normal tissue may even allow for administration of an increased dose to the target volume without exceeding the usually accepted tolerance limits of surrounding critical structures. However, there are some situations where current strategies remain unsatisfactory. If innovative approaches could be developed, many patients would be able to receive more effective treatment. Rational biological prevention strategies, which might represent one possible approach, require a detailed understanding of the complex and dynamic pathophysiological changes, possibly resulting in manifestation of radiation-induced neurotoxicity. Considerable research efforts focused on histological as well as cellular and biochemical alterations have been undertaken over the last decades. Most of these experimental studies evaluated the development of late neurotoxicity, for example radiation necrosis either in the brain or the spinal cord (i.e., radiation myelopathy). Acute reactions, which mainly are the result of increased blood-brain-barrier permeability and edema, are self-limiting, of short duration, and treatable by corticosteroid administration. Early delayed reactions after 2–6 months are caused by transient demyelination, often combined with perturbance of the blood-brain barrier. In patients, they might result in somnolence and headache or Lhermitte’s syndrome for a limited time span. Compared to these, the clinical implications of late reactions such as radionecrosis or leukencephalopathy are much more important. In addition to their potentially severe consequences for the patients' quality of life, they represent a major therapeutic challenge. So far, treatment is limited to a few strategies with inconsistent outcome, such as anticoagulation or sometimes surgical removal of necrosis. This chapter contains a review of current pathogenetic models of radiation necrosis as well as a discussion of the perspectives of newly developed preclinical prevention strategies.

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Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany

    C. Nieder MD & N. Andratschke MD

  2. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 97, Houston, TX, 77030, USA

    K. K. Ang MD, PhD

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  1. C. Nieder MD
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  2. N. Andratschke MD
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  3. K. K. Ang MD, PhD
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  1. Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Germany

    Carsten Nieder MD

  2. Department of Experimental Radiation Oncology, UT MD Anderson Cancer Center, 1515 Holcombe Blvd., P.O. Box 66, Houston, TX, 77030, USA

    Luka Milas MD, PhD

  3. Department of Radiation Oncology, UT MD Anderson Cancer Center, 1515 Holcombe Blvd., P.O. Box 66, Houston, TX, 77030, USA

    K. Kian Ang MD, PhD

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Nieder, C., Andratschke, N., Ang, K.K. (2003). Mechanisms and Modification of the Radiation Response of the Central Nervous System. In: Nieder, C., Milas, L., Ang, K.K. (eds) Modification of Radiation Response. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55613-5_6

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  • DOI: https://doi.org/10.1007/978-3-642-55613-5_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-62670-8

  • Online ISBN: 978-3-642-55613-5

  • eBook Packages: Springer Book Archive

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