title: Pathobiology of radiation myelopathy and strategies to mitigate injury.
abstract: METHODS
  This is a narrative review of the literature.
  
  
  OBJECTIVE
  The objectives of this study were to review the current concepts underlying the pathobiology of radiation-induced spinal cord injury; to discuss potential biologic strategies to mitigate spinal cord injury following radiation; and to provide an update on the clinical guidelines to prevent injury in the era of image-guided stereotactic body radiotherapy (SBRT).
  
  
  METHODS
  This study was conducted in Toronto, Canada.
  
  
  METHODS
  A MEDLINE search was performed using the following terms: radiation injury; radiation myelopathy; CNS radiation injury; brain necrosis, radiation; demyelination, radiation; blood-brain barrier, radiation; white matter necrosis; and SBRT.
  
  
  CONCLUSIONS
  The biologic response of the spinal cord after radiation is a continuously evolving process. Death of vascular endothelial cells and disruption of the blood-spinal cord barrier leads to a complex injury response, resulting in demyelination and tissue necrosis. At present, there is no evidence that the pathobiology of cord injury after SBRT is different from that after standard fractionation. Although permanent myelopathy has become a rare complication following conventional fractionated radiation treatment, cases of radiation myelopathy have re-emerged with the increasing role of spine stereotactic body radiation therapy and reirradiation. Experimental biologic strategies targeting the injury response pathways hold promise in mitigating this dreaded late effect of radiation treatment.
authors: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: C S
authors: CS
authors: Wong
authors: Division of Neurosurgery and Spine Program, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
authors: M G
authors: MG
authors: Fehlings
authors: 1] Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada [2] Division of Neurosurgery and Spine Program, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
authors: A
authors: A
authors: Sahgal
mesh_terms: D000818:Animals; D017408:Guidelines as Topic; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D059906:Neuroimaging / Q000379:methods / Q000592:standards; D011878:Radiotherapy / Q000009:adverse effects* / Q000592:standards*; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000628:therapy*