Central nervous system changes complicating the use of radiotherapy for the treatment of a nasopharyngeal neoplasm in a diabetic patient.
A case is reported of a diabetic patient with a nasopharyngeal neoplasm who developed radiation induced brainstem damage even though irradiated at a conventional time-dose-volume relationship. The clinical course was correlated with autopsy findings which revealed radiation changes in the brainstem consisting primarily of vascular hyalinization with foci of infarction, edema, and demyelination. Atherosclerotic changes were conspicuously absent and therefore not the case of the alterations. The changes occurred three months after completion of therapy, which was more rapid than expected for radiation injury. It is hypothesized that diabetes may have predisposed the patient to this severe complication of standard therapy. More needs to be learned concerning the relationship between diabetes mellitus and radiation complications. Perhaps a modified time-dose relationship should be considered.
D000328:Adult; D001933:Brain Stem / Q000473:pathology / Q000528:radiation effects*; D048909:Diabetes Complications; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000473:pathology; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D013997:Time Factors