title: Radiation myelitis after hypofractionated radiotherapy with concomitant gefitinib.
abstract: We describe the case of a 71-year-old Caucasian female with primary disseminated non-small cell cancer of the lung, presented for palliative radiotherapy of metastatic spread to the 9th and 11th thoracic vertebrae without intramedullary growth. Palliative radiotherapy with daily fractions of 3 Gy and a cumulative dose of 36 Gy to thoracic vertebrae 8-12 was performed. The patient received concomitantly 250 mg gefitinib daily. After a latent period of 16 months, the patient developed symptoms of myelitis. Magnetic resonance imaging (MRI) did not reveal any bony or intraspinal tumor progression, but spinal cord signal alteration. No response to steroids was achieved. The neurological symptoms were progressive in August 2013 with the right leg being completely plegic. The left leg was incompletely paralyzed. Deep and superficial sensitivity was also diminished bilaterally. The patient was completely urinary and anally incontinent. Contrary to the clinical findings, a follow-up MRI (July 2013) showed amelioration of the former signal alterations in the spinal cord. The diagnosis of paraneoplastic myelopathy was refuted by a negative test for autologous antibodies. At the last clinical visit in May 2014, the neurological symptoms were stable. The last tumor-specific treatment the patient is receiving is erlotinib 125 mg/d.We reviewed the literature and found no reported cases of radiation myelopathy after the treatment in such a setting. The calculated probability of such complication after radiotherapy alone is statistically measurable at the level of 0.02%. We suppose that gefitinib could also play a role in the development of this rare complication.
authors: Department of Radiation Oncology, University Medicine Rostock, Südring 75, 18059, Rostock, Germany. Lewitzki_V@UKW.de.|Department of Radiation Oncology, University Würzburg, Joseph Schneider Str. 11, 97080, Würzburg, Germany. Lewitzki_V@UKW.de.
authors: Victor
authors: V
authors: Lewitzki
authors: Department of Radiation Oncology, University Medicine Rostock, Südring 75, 18059, Rostock, Germany. nicolaus.andratschke@usz.ch.|Department of Radiation Oncology, University Zürich, Rämistrasse 100, 8091, Zürich, Switzerland. nicolaus.andratschke@usz.ch.
authors: Nicolaus
authors: N
authors: Andratschke
authors: Department of Radiation Oncology, University Medicine Rostock, Südring 75, 18059, Rostock, Germany. Thomas.Kuhnt@medizin.uni-leipzig.de.|Department of Radiation Oncology, University Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany. Thomas.Kuhnt@medizin.uni-leipzig.de.
authors: Thomas
authors: T
authors: Kuhnt
authors: Department of Radiation Oncology, University Medicine Rostock, Südring 75, 18059, Rostock, Germany. guido.hildebrandt@uni-rostock.de.
authors: Guido
authors: G
authors: Hildebrandt
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D009187:Myelitis / Q000209:etiology*; D010166:Palliative Care; D011799:Quinazolines / Q000009:adverse effects*; D011832:Radiation Injuries / Q000209:etiology*; D013125:Spinal Neoplasms / Q000556:secondary / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000187:drug effects / Q000528:radiation effects
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib
references: Int J Radiat Oncol Biol Phys. 2013 Jul 15;86(4):777-84
references: 23601898
references: Neuropathology. 2001 Dec;21(4):247-65
references: 11837531
references: Radiother Oncol. 1995 Aug;36(2):158
references: 7501815
references: Clin Oncol (R Coll Radiol). 1996;8(3):176-81
references: 8814372
references: Clin Neurol Neurosurg. 1996 May;98(2):197-201
references: 8836601
references: J Clin Oncol. 2006 Sep 20;24(27):4517-20
references: 16983123
references: J Cancer Res Ther. 2006 Jul-Sep;2(3):105-18
references: 17998688
references: Clin Cancer Res. 2008 Feb 15;14(4):1266-73
references: 18281562
references: J Thorac Oncol. 2008 Mar;3(3):250-7
references: 18317067
references: Acta Oncol. 2008;47(5):928-36
references: 18568487
references: Int J Radiat Oncol Biol Phys. 2008 Aug 1;71(5):1455-9
references: 18243570
references: J Clin Oncol. 2009 Apr 10;27(11):1864-71
references: 19289630
references: Microvasc Res. 2009 Dec;78(3):278-85
references: 19596357
references: Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9
references: 20171502
references: Clin Neurol Neurosurg. 2010 May;112(4):353-6
references: 20060207
references: J Thorac Oncol. 2010 Sep;5(9):1382-90
references: 20686428
references: Mol Cancer. 2010;9:222
references: 20731837
references: Eur J Cancer. 2010 Dec;46(18):3287-93
references: 20708924
references: Acta Oncol. 2012 Mar;51(3):409-11
references: 22060135
references: Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):e43-52
references: 22516386
references: JAMA. 2003 Oct 22;290(16):2149-58
references: 14570950
references: Ann Oncol. 2004 Jul;15(7):1042-7
references: 15205197