Chemotherapy and radiotherapy causing radiation myelopathy: what is to blame?

摘要

The case of myelopathy after radiotherapy and chemotherapy reported by Seddon et al. , is of interest. The authors present a case of fatal cervical myelopathy in a 17-year-old boy who received neck and upper thoracic radiotherapy after high-dose alkylating-agent chemotherapy with busulphan and melphalan. Although the risk of radiation myelopathy following the delivery of 50 Gy mid-plane dose, conventionally fractionated to the neck by parallel-opposed, anterior and posterior, 6 MV X-ray portals is small, it is nonetheless present. The possibility of augmentation of that risk (i.e. reduced tissue tolerance to radiation) by alkylating-agent chemotherapy is intriguing, as this phenomenon is really only widely appreciated for intercalating drugs such as anthracyclines and actinomycin D, and the synergised central nervous system toxicity of methotrexate with radiotherapy .