Advertisement

Leukoencephalopathy after Chemotherapy and/or Radiotherapy

  • Jacob Valk
  • Marjo S. van der Knaap

Abstract

Radiotherapy and chemotherapy form, together with surgery, an integral part of the treatment of malignancy. When considering the brain, these modes of therapy are not only applied in the approach to primary brain tumors and cerebral metastases, but intrathecal administration of cytostatica and cranial irradiation are also widely used in the prophylaxis of cerebral metastases in cases of extracerebral malignancies. Furthermore, systemic chemotherapy, which is used in many kinds of extracerebral tumors, also reaches the brain. For many years the human brain was considered to be relatively resistant to therapeutic doses of radiation and chemotherapeutics. However, it has become necessary to modify this concept as it has now been established that adverse effects are not exceptional. These adverse effects can be divided into three groups according to time of appearance. There are acute reactions, which occur during the course of treatment; early delayed reactions, usually transient and appearing from a few weeks to a few months after treatment; and late delayed reactions with onset from several months to several years later.

Keywords

White Matter Cerebellar Ataxia Cranial Irradiation White Matter Change Cerebral Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bates S, McKevver P, Masur H, Levens D, et al. (1985) Myelopathy following intrathecal chemotherapy in a patient with extensive Burkitt’s lymphoma and altered immune status. Am J Med 78: 697–702PubMedCrossRefGoogle Scholar
  2. Breuer AC, Blank NK, Schoene WC (1978) Multifocal Pontine lesions in cancer patients treated with chemotherapy and CNS radiotherapy. Cancer 41: 2112–2120PubMedCrossRefGoogle Scholar
  3. Burger PC, Kamenar E, Schold SC, Fay JW, et al. (1981) Encephalomyelopathy following high-dose BCNU therapy. Cancer 48: 1318–1327CrossRefGoogle Scholar
  4. Burger PC, Mahaley MS, Dudka L, Vogel FS (1979) The morphologic effects of radiation administered therapeutically for intracranial gliomas. Cancer 44: 1256–1272PubMedCrossRefGoogle Scholar
  5. Catane R, Schwade JG, Yarr I, Lichter AS, et al. (1981) Follow-up neurological evaluation in patients with small cell lung carcinoma treated with prophylactic cranial irradiation and chemotherapy. Int J Radiat Oncol Biol Phys 7: 105–109PubMedCrossRefGoogle Scholar
  6. Courville CB, Myers RO (1958) The process of demyelination in the central nervous system. J Neuropathol Exp Neurol 17: 158–173PubMedCrossRefGoogle Scholar
  7. Craig JB, Jackson DV, Moody D, Cruz JM, et al. (1984) Prospective evaluation of changes in computed cranial tomography in patients with small cell lung carcinoma treated with chemotherapy and prophylactic cranial irradiation. J Clin Oncol 2: 1151–1156PubMedGoogle Scholar
  8. Curnes JT, Laster DW, Ball MR, Moody DM, et al. (1986) Magnetic resonance imaging of radiation injury to the brain. AJNR 7: 389–394Google Scholar
  9. Di Chiro G, Oldfield E, Wright DC, De Michele D, et al. (1987) Cerebral necrosis after radiotherapy and/or intra-arterial chemotherapy for brain tumors: PET and neuro-pathologic studies. AJNR 8: 1083–1091Google Scholar
  10. Dooms GC, Hecht S, Brant-Zawadzki M, Berthiaume Y, et al. (1986) Brain radiation lesions: MR imaging. Radiology 158: 149–155Google Scholar
  11. Flament-Durand J, Ketelbant-Balase P, Maurus R, Regnier R, et al. (1975) Intracerebral calcifications appearing during the course of acute lymphocytic leukemia treated with methotrexate and X rays. Cancer 35: 319–325PubMedCrossRefGoogle Scholar
  12. Fukamachi A, Wakao T, Akai J (1982) Brain stem necrosis after irradiation of pituitary adenoma. Surg Neurol 18: 343–350PubMedCrossRefGoogle Scholar
  13. Haymaker W, Ibrahim MZM, Miguel J, Call N, et al. (1968) Delayed radiation effects in the brains of monkeys exposed to X- and Y-rays. J Neuropathol Exp Neurol 27: 50–79PubMedCrossRefGoogle Scholar
  14. Hecht-Leavitt C, Grossman RI, Curran WJ, McGrath JT, et al. (1987) MR of brain radiation injury: Experimental studies in cats. AJNR 8: 427–430Google Scholar
  15. Johnson BE, Becker B, Goff WB, Petronas N, et al. (1985) Neurologic, neuropsychologic, and computed cranial tomography scan abnormalities in 2- to 10-year survivors of small-cell lung cancer. J Clin Oncol 3: 1659–1667PubMedGoogle Scholar
  16. Kleinschmidt-Demasters BK (1986) Intracarotid BCNU leukoencephalopathy. Cancer 57: 1276–1280PubMedCrossRefGoogle Scholar
  17. Lampert PW, Davis RL (1964) Delayed effects of radiation on the human central nervous system. Neurology 14: 912–917PubMedCrossRefGoogle Scholar
  18. Lee YY, Nauert C, Glass JP (1986) Treatment-related white matter changes in cancer patients. Cancer 57: 1473–1482PubMedCrossRefGoogle Scholar
  19. Leibel SA, Sheline GE (1987) Radiation therapy for neoplasms of the brain. J Neurosurg 66: 1–22PubMedCrossRefGoogle Scholar
  20. Martins AN, Johnston JS, Henry JM, Stoffel TJ, et al. (1977) Delayed radiation necrosis of the brain. J Neurosurg 47: 336–345PubMedCrossRefGoogle Scholar
  21. Mikhael MA (1978) Radiation necrosis of the brain: Correlation between computed tomography, pathology, and dose distribution. J Comput Assist Tomogr 2: 71–80PubMedCrossRefGoogle Scholar
  22. Mikhael MA (1979) Radiation necrosis of the brain: Correlation patterns on computed tomography and dose of radiation. J Comput Assist Tomogr 3: 241–249PubMedCrossRefGoogle Scholar
  23. Pratt RA, Di Chiro G, Weed JC (1977) Cerebral necrosis following irradiation and chemotherapy for metastatic choriocarcinoma. Surg Neurol 7: 117–120PubMedGoogle Scholar
  24. Price RA, Jamieson PA (1975) The central nervous system in childhood leukemia. Cancer 35: 306–318PubMedCrossRefGoogle Scholar
  25. Rizzoli HV, Pagnanelli DM (1984) Treatment of delayed radiation necrosis of the brain. J Neurosurg 60: 589–594PubMedCrossRefGoogle Scholar
  26. Rottenberg DA, Chernik NL, Deck MDF, Ellis F, et al. (1977) Cerebral necrosis following radiotherapy of extra-cranial neoplasms. Ann Neurol 1: 339–357PubMedCrossRefGoogle Scholar
  27. Rottenberg DA, Horten B, Kim JH, Posner JB (1980) Progressive white matter destruction following irradiation of an extracranial neoplasm. Ann Neurol 8: 76–78PubMedCrossRefGoogle Scholar
  28. Rubinstein LJ, Herman MM, Long TF, Wilbur JR (1975) Disseminated necrotizing leukoencephalopathy: a complication of treated central nervous system leukemia and lymphoma. Cancer 35: 291–305PubMedCrossRefGoogle Scholar
  29. Safdari GHH, Fuentes JM, Dubois JB, Alirezai M, et al. (1985) Radiation necrosis of the brain: time of onset and incidence related to total dose and fractionation of radiation. Neuroradiology 27: 44–47PubMedCrossRefGoogle Scholar
  30. Sheline GE (1980) Irradiation injury of the human brain: a review of clinical experience. In: Gilbert HA, Kagan AR, eds. Radiation damage to the nervous system. New York: Raven Press: 39–58Google Scholar
  31. So NK, O’Neill BP, Frytak S, Eagan RT, et al. (1987) Delayed leukoencephalopathy in survivors with small cell lung cancer. Neurology 37: 1198–1201PubMedCrossRefGoogle Scholar
  32. Tsuruda JS, Kortman KE, Bradley WG, Wheeler DC, et al. (1987) Radiation effects on cerebral white matter: MR evaluation. AJNR 8: 431–437Google Scholar
  33. Wang AM, Skias DD, Rumbaugh CL, Schoene WC, et al. (1983) Central nervous system changes after radiation therapy and/or chemotherapy: Correlation of CT and autopsy findings. AJNR 4: 466–471Google Scholar
  34. Wilson WB, Perez GM, Kleinschmidt-Demasters K (1987) Sudden onset of blindness in patients treated with oral CCNU and low-dose cranial irradiation. Cancer 59: 901–907PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • Jacob Valk
    • 1
  • Marjo S. van der Knaap
    • 2
  1. 1.Department of Diagnostic Radiology and NeuroradiologyFree University HospitalAmsterdamThe Netherlands
  2. 2.Department of Child NeurologyAcademic HospitalUtrechtThe Netherlands

Personalised recommendations