1
|
Porter AB. Neurologic Complications of Cancer Treatment. Continuum (Minneap Minn) 2023; 29:903-922. [PMID: 37341335 DOI: 10.1212/con.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Advances in cancer treatment have led to extended survival and increased risk of neurologic complications in an aging population. This review summarizes potential neurologic complications in patients who have undergone treatment for neurologic and systemic malignancies. LATEST DEVELOPMENTS Radiation and cytotoxic chemotherapy along with other targeted therapies continue to be the mainstay of cancer treatment. These advances in cancer care have led to improved outcomes and increased the need to understand the spectrum of neurologic complications that may arise from treatment. While radiation and older therapies including cytotoxic chemotherapies have side effect profiles that are widely known and well understood, this article serves as a review of the more commonly associated neurologic complications of both traditional and newer treatments being offered to this patient population. ESSENTIAL POINTS Neurotoxicity is a common complication of cancer-directed treatment. In general, neurologic complications of radiation therapy are more common in central nervous system malignancies, and neurologic complications of chemotherapy are more common in non-neurologic malignancies. Attempts at prevention, early detection, and intervention remain paramount in the reduction of neurologic morbidity.
Collapse
|
2
|
Choudhury S, Purandare N, Shah S, Agrawal A, Rangarajan V. 18 F-FDG PET/CT Appearance of Radiation-Induced Delayed Transverse Myelitis. Clin Nucl Med 2022; 47:e589-e590. [PMID: 35451999 DOI: 10.1097/rlu.0000000000004232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Delayed-onset radiation-induced myelitis is a rare but serious complication of radiation exposure to the spinal cord. In this report, we describe the 18 F-FDG PET/CT findings of radiation-induced myelitis in a patient with carcinoma of buccal mucosa treated with external beam radiotherapy.
Collapse
Affiliation(s)
- Sayak Choudhury
- From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
3
|
Abstract
Multiple diverse pathologies result in the clinical presentation of myelopathy. The preferred way to image the spinal cord depends on clinical history, anatomic site of interest, and patient issues limiting certain imaging modalities. This radiology-focused article discusses pertinent physiological considerations, reviews basic and newer imaging techniques, and examines several distinct disease entities in order to highlight the key role of imaging in the work-up of myelopathy.
Collapse
Affiliation(s)
- Alice C Shea
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Anderson H Kuo
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Harata N, Yoshida K, Oota S, Fujii H, Isogai J, Yoshimura R. (18)F-FDG uptake of the spinal cord was decreased after conventional dose radiotherapy in esophageal cancer patients. Ann Nucl Med 2015; 30:35-9. [PMID: 26370717 DOI: 10.1007/s12149-015-1027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We retrospectively investigated changes of (18)F-fluorodeocyglucose ((18)F-FDG) uptake in the spinal cord, inside and outside the radiation fields, in patients with esophageal cancer before and after conventional dose radiotherapy. METHODS A total of 17 consecutive patients with esophageal cancer (16 males, one female; age 50-83 years, mean 67.0 years), who underwent conventional dose radiotherapy and (18)F-FDG PET/CT before and 5.1 months (range 1.6-8.6 months) after the radiotherapy, were retrospectively evaluated. Sixteen patients had esophageal cancer and one patient had esophageal metastasis from thyroid cancer. Mean standardized uptake values (SUVmean) of the cervical, thoracic (inside and outside the radiation fields) and lumbar spinal cord were measured. RESULTS SUVmean of the thoracic spinal cord inside the radiation field was decreased significantly after radiotherapy compared to those before radiotherapy (p < 0.001). SUVmean of the cervical spinal cord showed the same trend but it was not statistically significant (p = 0.051). SUVmean of the thoracic spinal cord outside the radiation field and the lumbar spinal cord did not differ significantly before and after the radiotherapy (p = 0.146 and p = 0.701, respectively). CONCLUSIONS The results suggest that glucose metabolism of the spinal cord is decreased in esophageal cancer patients after conventional dose radiotherapy.
Collapse
Affiliation(s)
- Naoki Harata
- Department of Radiation Oncology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyoku, Tokyo, 113-8519, Japan.
| | | | - Sayako Oota
- Department of Radiology, Asahi General Hospital, Chiba, Japan
| | - Hayahiko Fujii
- Department of Radiology, Asahi General Hospital, Chiba, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Chiba, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Oncology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyoku, Tokyo, 113-8519, Japan
| |
Collapse
|
5
|
Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord 2015; 53:574-80. [DOI: 10.1038/sc.2015.43] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/09/2015] [Accepted: 02/04/2015] [Indexed: 01/25/2023]
|
6
|
Watanabe M, Kondo T, Murakata K, Kageyama T, Shibata Y, Takahashi T, Nomura K, Matsumoto S. Antibodies to neural and non-neural autoantigens in Japanese patients with CNS demyelinating disorders. J Neuroimmunol 2014; 274:155-60. [DOI: 10.1016/j.jneuroim.2014.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/29/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
|
7
|
Eicker SO, Langen KJ, Galldiks N, Stoffels G, Herdmann J, Steiger HJ, Floeth FW. Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy. Neurosurg Focus 2013; 35:E2. [DOI: 10.3171/2013.3.focus1379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical spondylotic myelopathy (CSM) is one of the most common spinal cord disorders in the elderly. It is usually diagnosed by MRI, but in a significant number of patients the clinical course of CSM does not correlate with the extent of the spinal cord compression. Recent studies have suggested that a distinct metabolic pattern of the cervical cord, as assessed by PET with 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) may predict a patient's clinical outcome after decompressive surgery for cervical spine stenosis. The authors provide an overview of the recent literature regarding the value of PET with 18F-FDG of the cervical cord in patients with CSM, paying attention to prognostic aspects and the potential role of inflammatory processes in the acute phase of the disease.
Collapse
Affiliation(s)
- Sven O. Eicker
- 1Department of Neurosurgery, University of Düsseldorf
- 5Department of Neurosurgery, University of Hamburg-Eppendorf, Germany
| | | | - Norbert Galldiks
- 2Institute of Neuroscience and Medicine, Research Center Jülich
- 3Department of Neurology, University of Cologne
| | | | - Jörg Herdmann
- 4Department of Spine and Pain, St.-Vinzenz-Hospital, Düsseldorf; and
| | | | - Frank W. Floeth
- 1Department of Neurosurgery, University of Düsseldorf
- 4Department of Spine and Pain, St.-Vinzenz-Hospital, Düsseldorf; and
| |
Collapse
|
8
|
Stroman PW, Wheeler-Kingshott C, Bacon M, Schwab JM, Bosma R, Brooks J, Cadotte D, Carlstedt T, Ciccarelli O, Cohen-Adad J, Curt A, Evangelou N, Fehlings MG, Filippi M, Kelley BJ, Kollias S, Mackay A, Porro CA, Smith S, Strittmatter SM, Summers P, Tracey I. The current state-of-the-art of spinal cord imaging: methods. Neuroimage 2013; 84:1070-81. [PMID: 23685159 DOI: 10.1016/j.neuroimage.2013.04.124] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 12/28/2022] Open
Abstract
A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small cross-sectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research.
Collapse
Affiliation(s)
- P W Stroman
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ahn SJ, Kim IO. Spinal cord glioblastoma induced by radiation therapy of nasopharyngeal rhabdomyosarcoma with MRI findings: case report. Korean J Radiol 2012; 13:652-7. [PMID: 22977336 PMCID: PMC3435866 DOI: 10.3348/kjr.2012.13.5.652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 12/06/2011] [Indexed: 11/15/2022] Open
Abstract
Radiation-induced spinal cord gliomas are extremely rare. Since the first case was reported in 1980, only six additional cases have been reported.; The radiation-induced gliomas were related to the treatment of Hodgkin's lymphoma, thyroid cancer, and medullomyoblastoma, and to multiple chest fluoroscopic examinations in pulmonary tuberculosis patient. We report a case of radiation-induced spinal cord glioblastoma developed in a 17-year-old girl after a 13-year latency period following radiotherapy for nasopharyngeal rhabdomyosarcoma. MRI findings of our case are described.
Collapse
Affiliation(s)
- Se Jin Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | | |
Collapse
|
10
|
Floeth FW, Stoffels G, Herdmann J, Eicker S, Galldiks N, Steiger HJ, Langen KJ. Prognostic Value of 18F-FDG PET in Monosegmental Stenosis and Myelopathy of the Cervical Spinal Cord. J Nucl Med 2011; 52:1385-91. [DOI: 10.2967/jnumed.111.091801] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Floeth FW, Stoffels G, Herdmann J, Jansen P, Meyer W, Steiger HJ, Langen KJ. Regional impairment of 18F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy. Eur Radiol 2010; 20:2925-32. [DOI: 10.1007/s00330-010-1877-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 06/01/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
|
12
|
Abstract
The central nervous system (CNS) and peripheral nervous system (PNS) are very susceptible to cancer and its treatment. The most direct involvement of the nervous system manifests in the development of primary brain and spinal cord tumors. Many cancers exhibit a propensity toward spread to the CNS, and brain metastases are common problems seen in malignancies such as lung, breast, and melanoma. Such spread may involve the brain or spine parenchyma or the subarachnoid space. In the PNS, spread is usually through direct infiltration of nerve roots, plexi, or muscle by neighboring malignancies. In some cases, cancer has sudden, devastating effects on the nervous system: epidural spinal cord compression or cord transection from pathologic fractures of vertebra involved by cancer; increased intracranial pressure from intracranial mass lesion growth and edema; and uncontrolled seizure activity as a result of intracranial tumors (status epilepticus), which are neuro-oncologic emergencies. The best known indirect or remote effects of cancer on the nervous system are the neurologic paraneoplastic syndromes. Cancer can also result in a hypercoagulable state causing cerebrovascular complications. Treatment of cancer can have neurologic complications. The commonest of these complications are radiation-induced injury to the brain, spine, and peripheral nerves and chemotherapy-induced peripheral neuropathy. The suppressant effect of cancer and its treatment on the body's immune system can result in infectious complications within the nervous system.
Collapse
|