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When radiation is used to treat nervous system cancer,exposure of adjacent normal nervous system tissue is unavoidable,and radiation-induced injury may occur.Acute injury is usually mild and transient,but late forms of radiation-induced nervous system injury are usually progressive and debilitating.Treatment with corticosteroids,surgery and antioxidants of often ineffective.We treated 11 patients with late radiation-induced nervous system injuries(eight with cerebral radionecrosis,one with a myelopathy,and two with plexopathies,all unresponsive to dexamethasone and prednisone)with full anticoagulation.Some recovery of function occurred in five of the eight patients with cerebral radionecrosis,and all of the patients with myelopathy or plexopathy.Anticoagulation was continued for 3 to 6 months.In one patient with cerebral radionecrosis,symptoms recurred after discontinuation of anticoagulation and disappeared again after reinstitution of treatment.We hypothesize that anticoagulation may arrest and reverse small-vessel endothelial injury,the fundamental lesion of radiation necrosis-and produce clinical improvement in some patients. |
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anticoagulant,treatment
brachial plexus neuropathy
coumarin
heparin
myelopathy
myelopathy,radiation induced
radiation encephalopathy,delayed
radiation necrosis
radiation neuropathy
radiation therapy,CNS treatment and complications with
treatment of neurologic disorder
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