Neurobehavioral toxicity of total body irradiation: a follow-up in long-term survivors.
OBJECTIVE
Total body irradiation (TBI) in preparation for bone marrow transplantation (BMT) is a routine treatment of hematological malignancy. A retrospective and a prospective group study of long-term cerebral side effects was performed, with a special emphasis on neurobehavioral toxicity effects.


METHODS
Twenty disease-free patients treated with hyperfractionated TBI (14.4 Gy, 12 x 1.2 Gy, 4 days), 50 mg/kg cyclophosphamide, and autologous BMT (mean age 38 years, range 17-52 years; age at TBI 35 years, 16-50 years; follow-up time 32 months, 9-65 months) participated in a neuropsychological, neuroradiological, and neurological examination. Data were compared to 14 patients who were investigated prior to TBI. Eleven patients with renal insufficiencies matched for sex and age (38 years, 20-52 years) served as controls. In a longitudinal approach, neuropsychological follow-up data were assessed in 12 long-term survivors (45 years, 23-59 years; follow-up time 8.8 years, 7-10.8 years; time since diagnosis 10.1 years, 7.5-14.2 years).


RESULTS
No evidence of neurological deficits was found in post-TBI patients except one case of peripheral movement disorder of unknown origin. Some patients showed moderate brain atrophy. Neuropsychological assessment showed a subtle reduction of memory performance of about one standard deviation. Cognitive decline in individual patients appeared to be associated with pretreatment (brain irradiation, intrathecal methotrexate). Ten-years post disease onset, survivors without pretreatment showed behavioral improvement up to the premorbid level.


CONCLUSIONS
The incidence of long-term neurobehavioral toxicity was very low for the present TBI/BMT regimen.
Peper
M
M
Department of Psychology, University of Freiburg, Germany. peper@psychologie.uni-freiburg.de
Steinvorth
S
S
Schraube
P
P
Fruehauf
S
S
Haas
R
R
Kimmig
B N
BN
Lohr
F
F
Wenz
F
F
Wannenmacher
M
M
D000293:Adolescent; D000328:Adult; D000339:Affect / Q000528:radiation effects; D001284:Atrophy; D001519:Behavior / Q000528:radiation effects; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D003071:Cognition / Q000528:radiation effects*; D003430:Cross-Sectional Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008568:Memory / Q000528:radiation effects*; D008875:Middle Aged; D009483:Neuropsychological Tests; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D017741:Survivors; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation / Q000009:adverse effects*