Guidelines for Complications of Cancer Treatment Vol VIII Part B

tried 36 . Novel therapies as stem cell therapy are still inpreclinical stage 37Follow up: The patient is seen every day or week until relief isobtained and then at 1- to 3-month intervals. Intensive nursingand rehabilitative care are essential, and medico legalimplications should be carefully assessed. Like other spinalcord injury patients, most patients ultimately succumb topneumonitis, bed sores, septicemia or pulmonarythromboembolism. A dedicated spinal or neuro rehabilitationprogram can ensure best possible care.Prevention:Careful Radiation Therapy planning in which care is taken tonot to exceed the dose to spinal cord more than 45 to 50 Gyusing conventional fractionation by using various techniquesas going off cord after an initial phase, using oblique spinesparing portals, using spinal blocks, careful matching of fieldjunctions etc. are examples of methods used duringconventional planning. Modern high precision photon, protonor charged particle Radiation Therapy whenever available canalso ensure lower doses to cord. A strict Quality Assurance(QA) program for all the steps and equipments of treatmentlike dosimetry, setup, and treatment delivery is essential toensure coherence of planning and final treatment. Care shouldbe taken to avoid potential neurotoxic chemotherapeutic agentsduring radiation therapy if spinal cord is getting substantialdose.References1. Scultheiss TE et al. Radiation response of the centralnervous system. Int J Radiat Oncol Biol Phys. 1995;31(5): 1093- I112,2. Posner JB. Side effects of radiation therapy. NeurologicalComplications of Cancer. Posner JB, ed. FA Davis,Philadelphia, 1995: 311–337.336