[Biological prevention and/or therapy possibility of radiation myelopathy. A discussion of recent perspectives].
BACKGROUND
Radiosensitivity of the spinal cord makes both curative first-line treatment of numerous malignancies and re-irradiation of recurrent or second tumors more difficult. This review discusses recent advances in basic research that alter the view on the pathogenesis of radiation myelopathy, possibly offering strategies for prevention and/or therapy.


RESULTS
Available data of developmental neurobiology and preclinical studies of demyelinating diseases revealed interesting insights into oligodendrocyte development, intercellular signaling pathways, and myelination processes. Current findings suggest that administration of cytokines could increase proliferation of oligodendrocyte progenitor cells, enhance their differentiation, upregulate synthesis of myelin constituents, and promote myelin regeneration in the adult central nervous system (Table 1). Other compounds might also be able to modulate progression of pathogenic processes that eventually lead to radiation myelopathy. This offers several possible biological prevention and/or treatment strategies, which currently are being investigated in animal studies (Table 2).


CONCLUSIONS
Technical options as well as optimization of fractionation parameters should be given priority in the attempt to reduce iatrogenic neurotoxicity. However, rational biological strategies could offer a new perspective for many patients.
Nieder
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Department of Experimental Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, USA. cnied@hotmail.com
Ataman
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Price
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Ang
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D000328:Adult; D000818:Animals; D016207:Cytokines / Q000627:therapeutic use; D006801:Humans; D009416:Nerve Regeneration / Q000187:drug effects / Q000528:radiation effects; D009836:Oligodendroglia / Q000187:drug effects / Q000528:radiation effects; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D011836:Radiation Tolerance; D013116:Spinal Cord / Q000528:radiation effects*
D016207:Cytokines