Chao M W, Wirth A, Ryan G, MacManus M, Liew K H
Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia.
Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1057-61. doi: 10.1016/s0360-3016(98)00107-2.
Combined modality therapy with chemotherapy and radiotherapy has become increasingly popular in the management of solid malignancies. However, unexpected toxicities may arise from their interactions.
We report the case of a young woman with a large mediastinal non-Hodgkin's lymphoma who underwent high-dose chemotherapy with autologous bone marrow transplantation and involved field radiotherapy, and who developed radiation myelopathy after a latent period of only 3 months. The spinal cord dose did not exceed 40.3 Gy in 22 fractions over 4.5 weeks, which is well within accepted tolerance limits. She had no other identifiable risk factors for radiation myelopathy, suggesting an adverse drug-radiation interaction as the most likely cause of her injury.
This represents the first report of radiation myelopathy at accepted safe radiation doses following high-dose chemotherapy with autologous bone marrow transplantation, and we recommend caution in the choice of radiotherapeutic dose in this setting.
化疗和放疗相结合的综合治疗方法在实体恶性肿瘤的治疗中越来越普遍。然而，它们的相互作用可能会产生意想不到的毒性。
我们报告了一名患有巨大纵隔非霍奇金淋巴瘤的年轻女性病例，她接受了高剂量化疗联合自体骨髓移植及受累野放疗，仅在3个月的潜伏期后就发生了放射性脊髓病。脊髓剂量在4.5周内分22次给予，不超过40.3戈瑞，这完全在可接受的耐受限度内。她没有其他可识别的放射性脊髓病风险因素，提示药物-放疗不良相互作用是其损伤最可能的原因。
这是自体骨髓移植高剂量化疗后在公认的安全放疗剂量下发生放射性脊髓病的首例报告，我们建议在这种情况下选择放疗剂量时要谨慎。
