Naghavi Saba, Motahharynia Ali, Fatemi Farnaz, Ahmadi Elaheh, Mokhtari Faezeh, Adibi Iman
Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran.
Strahlenther Onkol. 2024 Sep;200(9):827-831. doi: 10.1007/s00066-023-02150-1. Epub 2023 Sep 19.
Delayed radiation myelopathy (DRM) is a rare yet severe complication of radiotherapy. This condition has a progressive pattern that is often irreversible. Several therapeutic strategies have been introduced to alleviate disease complications, including corticosteroids, hyperbaric oxygen, anticoagulants, and antivascular endothelial growth factor (VEGF) agents. However, despite their beneficial effect, they have not been the definitive treatments for DRM. Here we present the case of a 55-year-old woman with a history of multiple myeloma who developed neurological complications 11 months after radiation therapy. As her radiologic findings demonstrated transverse myelitis, based on the DRM diagnostic criteria, the diagnosis of delayed radiation myelitis was reached. Therefore, methylprednisolone pulse therapy was initiated, resulting in the complete resolution of her neurological symptoms. However, on her follow-up examination, although she did not have new neurological complications, magnetic resonance imaging (MRI) demonstrated a residual enhancement in the thoracic spinal cord area. Hence, due to the possibility of myelitis progression and spinal cord atrophy, intravenous immune globulin (IVIG) was administered, resulting in the resolution of lesion enhancement. Considering this outcome and the immunomodulatory properties of IVIG, it could be regarded as a potential therapeutic option in the case of DRM activity.
迟发性放射性脊髓病（DRM）是放疗一种罕见但严重的并发症。这种病症呈进行性发展，通常不可逆转。已经引入了几种治疗策略来减轻疾病并发症，包括皮质类固醇、高压氧、抗凝剂和抗血管内皮生长因子（VEGF）药物。然而，尽管它们有有益作用，但并非DRM的确定性治疗方法。在此，我们报告一例55岁患有多发性骨髓瘤病史的女性患者，其在放疗11个月后出现神经并发症。由于其影像学表现显示为横贯性脊髓炎，根据DRM诊断标准，确诊为迟发性放射性脊髓炎。因此，开始给予甲泼尼龙冲击治疗，其神经症状完全缓解。然而，在她的随访检查中，尽管她没有新的神经并发症，但磁共振成像（MRI）显示胸段脊髓区域有残留强化。因此，鉴于脊髓炎进展和脊髓萎缩的可能性，给予静脉注射免疫球蛋白（IVIG），病变强化得以消退。考虑到这一结果以及IVIG的免疫调节特性，在DRM活动的情况下，它可被视为一种潜在的治疗选择。
