Neurological complications of radiation in lymphoma and leukemia patients
Carcinoma, Non-Small-Cell Lung
© Springer Science+Business Media, LLC 2012. All rights reserved.Neurotoxicity associated with radiotherapy and chemotherapy is a significant problem in patients with primary central nervous system lymphoma (PCNSL) given their relatively long survival. Radiation can produce progressive damage to the central nervous system through vascular injury, demyelination of the white matter, cerebral atrophy, and necrosis; DNA damage and disruption in hippocampal neurogenesis have also been reported following radiation. Delayed treatment-related cognitive dysfunction is a significant problem, now that effective treatment for PCNSL has increased survival rates. A diffuse pattern of cognitive deficits has been described in patients treated with whole-brain radiotherapy and high-dose methotrexate-based chemotherapy. The toxicity of prophylactic irradiation has been documented primarily in children with leukemia, and recent interventions using modified chemotherapy regimens without radiotherapy showed improved survival and a reduction in CNS relapse. Although there are no established preventive or therapeutic interventions for radiotherapy-induced injury, this is an area of growing interest and several agents are currently under investigation.
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