Adverse radiation effects after radiosurgery may benefit from oral vitamin E and pentoxifylline therapy: a pilot study.
BACKGROUND
Although uncommon, adverse radiation effects (ARE) are a potentially serious side effect of brain stereotactic radiosurgery (SRS). Corticosteroids are used to treat suspected ARE but side effects may be significant after long-term usage. Oral pentoxifylline (Ptx) and vitamin E therapy (VitE) are reported to benefit ARE seen in other organ systems. We treated 11 patients with suspected ARE after SRS with Ptx and VitE.


METHODS
To assess the response, edema was measured using fluid-attenuated inversion recovery magnetic resonance imaging (MRI). Edema volumes were calculated by first determining the three maximum measurements in the X, Y, and Z planes of the image with the largest signal change. Volume was plotted over time for each patient that had serial MRI scans available. Two patients had 2 separate radiosurgeries and 2 patients underwent 3. Three patients received adjuvant whole-brain radiation therapy.


RESULTS
The time until clinical detection of ARE after SRS varied from 3 to 18 months (median, 8 months). The change in edema volume varied from 59.6 ml in 1 patient (worse edema) to -324.2 ml (improvement). The average change in edema from pre- to post-treatment was -72.3 ml. One patient had more edema despite treatment; this patient was found to have tumor recurrence, and not an ARE. Two patients discontinued Ptx because of persistent nausea and abdominal discomfort.


CONCLUSIONS
Ptx and VitE may be of benefit in the management of adverse radiation effects and should be studied further.
Williamson
Richard
R
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pa., USA.
Kondziolka
Douglas
D
Kanaan
Hilal
H
Lunsford
L Dade
LD
Flickinger
John C
JC
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage* / Q000627:therapeutic use; D010865:Pilot Projects; D016634:Radiosurgery / Q000009:adverse effects*; D024505:Tocopherols / Q000008:administration & dosage* / Q000627:therapeutic use
D024505:Tocopherols; D010431:Pentoxifylline