Dr. Sita of Northwestern University Feinberg School of Medicine has no relevant financial relationships to disclose.)
Dr. Kruser of Northwestern University Feinberg School of Medicine received honorariums from AstraZeneca as a member of a speaker's bureau and advisory board.)
Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from AbbVie and Novocure for speaking engagements, from Eisai for consulting work, and from Monetris as an advisory board member.)
Radiation myelopathy is a relatively rare, but potentially devastating, complication of therapeutic irradiation. As systemic treatments improve and patients live longer with cancer, the incidence of spinal metastases (cord, CSF, dural, epidural) will continue to increase and necessitate the application of palliative radiation, stereotactic body radiotherapy (SBRT), and re-irradiation to the spinal cord. Therefore, the incidence of radiation myelopathy will likely increase, and recognition of the subacute and chronic progressive forms of radiation myelopathy will become critical to distinguish from recurrent tumor and permit early intervention. The authors summarize the clinical features, pathophysiology, and management issues for patients with radiation myelopathy.
• Radiation myelopathy is a rare complication of modern therapeutic radiation.
• The generally accepted dose and fractionation parameters predicting the risk of radiation myelopathy may not necessarily apply to patients who receive a second course of radiation, concurrent radiation plus chemotherapy, or spinal stereotactic radiosurgery.
• Most patients with chronic progressive radiation myelopathy are permanently neurologically disabled; there is no proven effective therapy.
Historical note and terminology
Spinal cord injury following therapeutic radiation was first recognized in the mid-1940s, shortly after the introduction of megavoltage radiotherapy (Boden 1948; Greenfield and Stark 1948). The term "radiation myelopathy" encompasses at least three distinct clinicopathologic entities: (1) a common, but mild subacute (transient) myelopathy, (2) a less common, but catastrophic chronic progressive (delayed) myelopathy, and (3) an unusual selective lower motor neuron syndrome. Therapeutic radiation has also been implicated in spinal cord hemorrhage, the induction of spinal cord neoplasms, and development of vascular malformations.
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