Sterpi Angeliki-Erato, Triantafyllou Alexandros-Stavros, Tzanetakos Dimitrios, Ampantzi Eleni, Kitsos Dimitrios, Theodorou Aikaterini, Koutsouraki Effrosyni, Maili Maria, Stefanou Maria Ioanna, Moschovos Christos, Palaiodimou Lina, Tzartos John, Giannopoulos Sotirios, Tsivgoulis Georgios
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
First Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, 54124 Thessaloniki, Greece.
J Clin Med. 2024 Dec 12;13(24):7554. doi: 10.3390/jcm13247554.
Radiotherapy (RT) remains crucial in treating both primary and metastatic central nervous system cancer. Despite advancements in modern techniques that mitigate some toxic adverse effects, magnetic resonance imaging (MRI) scans still reveal a wide range of radiation-induced changes. Radiation can adversely affect neuroglial cells and their precursors, potentially triggering a demyelinating pattern similar to multiple sclerosis (MS). The aim of the current review is to investigate the occurrence and characteristics of such cases presented in the literature. We present the case of a 37-year-old female patient with multiple white matter lesions on a brain MRI, mimicking MS, after the completion of RT sessions. Additionally, a systematic review of the literature (PROSPERO id: CRD42024624053) was performed on 4 January 2024. The databases of MEDLINE and SCOPUS were searched. Case reports or case series of adult patients with white matter lesions in a brain MRI, consistent with the MAGNIMS criteria for MS plaques, after RT, were included in our final synthesis. The PRISMA guidelines were applied. The systematic search of the literature revealed 1723 studies, 7 of which conformed to our inclusion criteria, including seven patients in our final analysis. Four of them were female and the mean age was 39 ± 11 years. Several intracranial and extracranial RT types were performed. The symptoms occurred 3 ± 0.8 months after the completion of RT. Lesions were revealed in infratentorial, periventricular and subcortical white matter regions, but not in the spinal cord. All patients who received corticosteroids (83%) showed clinical improvement. Clinical and radiological recurrence occurred in two of the patients during the follow-up period. Fingolimod and Interferon beta-1a were administered to these two patients. Radiation-induced demyelination is a critical clinical and radiological entity that requires attention from both oncologists and neurologists. Comprehensive follow-up is essential to identify patients who may benefit from disease-modifying therapies and to distinguish them from those with pre-existing demyelinating conditions.
放射治疗（RT）在原发性和转移性中枢神经系统癌症的治疗中仍然至关重要。尽管现代技术的进步减轻了一些毒性不良反应，但磁共振成像（MRI）扫描仍显示出广泛的辐射诱导变化。辐射会对神经胶质细胞及其前体产生不利影响，可能引发类似于多发性硬化症（MS）的脱髓鞘模式。本综述的目的是研究文献中此类病例的发生情况和特征。我们报告了一例37岁女性患者，在完成放疗疗程后，脑部MRI显示有多个白质病变，类似于MS。此外，于2024年1月4日对文献进行了系统综述（PROSPERO编号：CRD42024624053）。检索了MEDLINE和SCOPUS数据库。最终纳入我们综合分析的是放疗后脑部MRI出现白质病变、符合MS斑块MAGNIMS标准的成年患者的病例报告或病例系列。应用了PRISMA指南。文献的系统检索共发现1723项研究，其中7项符合我们的纳入标准，最终分析包括7名患者。其中4名女性，平均年龄为39±11岁。进行了几种颅内和颅外放疗类型。症状在放疗结束后3±0.8个月出现。病变见于幕下、脑室周围和皮质下白质区域，但脊髓未受累。所有接受皮质类固醇治疗的患者（83%）临床症状均有改善。两名患者在随访期间出现临床和影像学复发。这两名患者接受了芬戈莫德和干扰素β-1a治疗。辐射诱导的脱髓鞘是一个关键的临床和影像学实体，需要肿瘤学家和神经学家的关注。全面的随访对于识别可能从疾病改善疗法中获益的患者并将他们与已有脱髓鞘疾病的患者区分开来至关重要。
