Schwartz D L, Schechter G P, Seltzer S, Chauncey T R
Department of Radiation Oncology, VA Puget Sound Health Care System, Seattle 98108-1595, USA.
Bone Marrow Transplant. 2000 Dec;26(12):1355-9. doi: 10.1038/sj.bmt.1702705.
Myelitis is a rare but well documented complication of therapeutic radiation exposure to the spinal cord and is characterized by delayed development of paresthesias, sensory changes and, in severe cases, progressive paresis and paralysis. Although accepted radiation tolerance limits for the spinal cord have successfully limited the incidence of this problem (45-50 Gy, in daily 1.8-2 Gy fractions), aggressive systemic therapy may render patients more susceptible to radiation-related neurotoxicity. We describe the case of a 38-year-old man with refractory non-Hodgkin's lymphoma who underwent matched sibling peripheral blood stem cell transplant following a conditioning regimen of cyclophosphamide (60 mg/kg x 2) and total body irradiation (120 cGy x 11). This was followed by delivery of 30.6 Gy involved-field radiation at 1.8 Gy/day to the mediastinum and left supraclavicular fossa for bulky residual tumor. Although maximum cumulative radiation dose to the spinal cord was less than 45 Gy, the patient subsequently developed progressive lower extremity weakness and MRI abnormalities of the spinal cord limited to the radiation field. This represents the second report in the literature of this unexpected complication, prompting a need to re-examine current guidelines for radiotherapy in the context of high-dose systemic treatment.
脊髓炎是治疗性脊髓放射暴露罕见但有充分文献记载的并发症，其特征为感觉异常、感觉改变延迟出现，严重时出现进行性轻瘫和瘫痪。尽管脊髓公认的放射耐受限度已成功限制了该问题的发生率（45 - 50 Gy，每日分次剂量1.8 - 2 Gy），积极的全身治疗可能使患者更易发生放射相关神经毒性。我们描述了一名38岁难治性非霍奇金淋巴瘤男性患者的病例，该患者在接受环磷酰胺（60 mg/kg×2）和全身照射（120 cGy×11）的预处理方案后，接受了同胞匹配外周血干细胞移植。随后，针对纵隔和左锁骨上窝的巨大残留肿瘤，以每天1.8 Gy的剂量给予30.6 Gy的累及野放射治疗。尽管脊髓的最大累积放射剂量小于45 Gy，但患者随后出现进行性下肢无力，且脊髓MRI异常局限于放射野。这是该意外并发症在文献中的第二篇报道，提示有必要在高剂量全身治疗背景下重新审视当前的放射治疗指南。
