Guidelines for Complications of Cancer Treatment Vol VIII Part B

worsening during the treatment should be carefully evaluatedfor acute vascular, mechanical events or tumor progression. 2Radiation injury to the spine is a very rare clinicalcomplication. Before making a diagnosis of radiationmyelopathy, three crucial points should be kept in mind 31. Rule out other common causes as tumor progression orspinal metastasis.2. Check that symptoms have rational pattern, for e.g. onlypain is never the symptom but typical sensory motordeficits at and below the anatomical site of irradiatedcord are.3. Third, the dose and time to expression of injury must beconsistent with a spinal cord radiation injury. For sensorymotor deficits as seen in delayed radiation myelopathy,a latency of less than 6 months is rare, and patients whoreceived cord doses of less than 50 Gy are not generallyat risk for radiation myelopathy.It may manifests either as an early-delayed, transient,essentially reversible adverse event known as ‘TransientRadiation Myelopathy’ or a late and irreversible serious eventknown as ‘Delayed Radiation Myelopathy’. Both the eventscan be more systematically understood using the Late Effectsof Normal Tissues (LENT) paradigm. 4Transient Radiation Myelopathy:Clinical detection : The clinical pattern, first described in 1964by Jones 5 , is generally limited to Lhermitte’s sign,characterized by brief unpleasant sensations of numbness,tingling, and/or often electric-like feelings going down fromthe neck to the spine and to the extremities and triggered bythe flexion of the neck. The clinical entity was characterizedby Lhermitte in conjunction with injuries and multiplesclerosis. 6 He noted that the symptomatology was most329