Guidelines for Complications of Cancer Treatment Vol VIII Part B

PET scan findings have been described as increased [18F]deoxyglucose and [15O]butanol uptakes, but a diminished[11C]methionine accumulation.MRI Study Early ( weeks) Delayed Late (years)( month(s))General finding Cord edema. Cord atrophyThere may be No SOL.T1 NO Change. Hypointense Iso/HypointenseT2 Diffusely Iso/HyperintensehyperintenseT1 Contrast 50-60% No enhancementenhancement 32Laboratory Tests: Moderately elevated protein and Myelinbasic protein is the most common finding in the CSF but lacksany specificity. Somatosensory evoked potentials showchanges correlated to the extent of the lesions 33 whereas spinalconduction velocity is decreased 34 .Differential Diagnosis: Epidural metastasis or compressionsecondary to vertebral metastases must be excluded forlymphoma and carcinoma. Exclusion diagnosis rules out otherdemyelinating diseases, paraneoplastic syndromes,degenerative spondylitis and hypertrophic arthritis in theintervertebral foramen.Pathologic Diagnosis: Essentially a clinicoradiologicaldiagnosis. In case SOL is visible image guided FNAC or biopsymay be done to rule out recurrences.Management: Corticosteroid as dexamethasone, which hasproven CNS activity and long half life is used with an intensiveintravenous schedule followed by slow oral tapering to stabilizeprogress. Most patients become steroid dependent. Most otherinterventions are experimental with vague clinical benefits.Hyperbaric Oxygen Therapy (HBOT) has been reported tostabilize as by Angibaud et al. 35 Anticoagulation has also been335