Two Children with Chronic Progressive Radiation Myelopathy

• Published in: The Japanese Journal of Pediatric Hematology Vol. 9; no. 3; pp. 190 - 195
• Main Authors: TAWA, Akio, OKAMURA, Takayuki, OKADA, Shintaro, ISHIHARA, Shigehiko, OHTA, Hideaki, HOSOI, Gaku, TAKAI, Kenji, OSUGI, Yuko, HARA, Junichi
• Format: Journal Article
• Language: Japanese
• Published: THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 1995; 特定非営利活動法人 日本小児血液・がん学会
• Subjects: chronic progressive radiation myelopathy; high-dose chemotherapy; radiotherapy
• ISSN: 0913-8706; 1884-4723
• DOI: 10.11412/jjph1987.9.190

We report two patients who developed chronic progressive radiation myelopathy (CPRM). Patient 1 was a 16-year-old boy with group IV rhabdomyosarcoma of cervical soft tissue. He underwent partial excision of the tumor and received systemic and intrathecal chemotherapy and 44 Gy of local radiotherapy (C4 through Th3). These therapies were followed by high-dose chemotherapy including thio-TEPA and busulfan with autologous bone marrow rescue. One year after the completion of the therapies, he developed CPRM. Patient 2 was a 15-year-old girl with acute lymphoblastic leukemia on the 3rd complete remission. She received 18 Gy of irradiation to whole brain during the 1st remission and another 18 Gy to whole brain and 9 Gy to spinal cord after her 1st CNS relapse. After successful reinduction therapy for the 2nd relapse in CNS and bone marrow, she underwent an allogeneic bone marrow transplantation (BMT). The preconditioning regimen consisted of 12 Gy total body irradiation, thio-TEPA and cyclophosphamide. Seven months after BMT, she developed CPRM at CO-C1 level, which was included in the area of whole-brain irradiation. In both patients, MR images showed a swelling of the cervical cord and ring-like images by gadolinium enhancement. Their neurological disability transiently responded to the administration of corticosteroid, but they developed progressive quadriplegia. Although it is reported that a dose of 45-50 Gy may be safe, these cases suggest that administration of high-dose chemotherapy combined with intrathecal chemotherapy and radiotherapy to the cord might increase the risk of developing CPRM.