Guidelines for Complications of Cancer Treatment Vol VIII Part B

since previous treatment, although weighing the risk andbenefits. 1Chemical/Biologic Modifiers: As in transient myelopathy,concomitant use of intrathecal and intravenouschemotherapeutic agents known to be associated withneurotoxicity include methotrexate, cisplatin, cytarabine, andothers. In randomized studies by Jeremic et al. investigatingthe role of concurrent cisplatin with hyperfractionatedradiotherapy in the treatment of head and neck (n=101) 27 andlung cancers (n=336) 28 , after cord doses of greater than 50 Gythere were no cases of radiation myelitis in patients receivingconcomitant cisplatin. The contribution of the intrathecalcomponent is unclear. In a series of 149 patients with cranialparameningeal rhabdomyosarcoma treated with both systemicand intrathecal chemotherapy (methotrexate, cytarabine andhydrocortisone) and concurrent radiotherapy to the primarytumor (with or without additional radiotherapy to the wholebrain and spine), five patients developed ascending myelitisresulting in quadriplegia at 5.5–9 months after initiation oftherapy (3.4%). They had received radiotherapy doses of 40–55 Gy to the upper cervical cord 29 . As with the treatment withradiation therapy alone, no dose response curves exist forchemoradiation at present. Thus it appears that when treatingyoung patients by aggressive chemoradiation with goodexpected survival, cord dose should be respected by usingconventional fractionation and total dose not higher thantraditional limits of 40 to 45Gy.Radiological Imaging: Spinal cord MRI is helpful 30.Early findings: May be normal during initial few weeks.Delayed findings: The locations of nonspecific lesionscorrelate with the site of radiation.Late findings: Years later may show spinal- cord atrophywithout any signal abnormality; a case of cystic formation inlate-delayed radiation myelopathy has also been reported 31 .334