title: Incidence and predictors of Lhermitte's sign among patients receiving mediastinal radiation for lymphoma.
abstract: OBJECTIVE
  To prospectively examine the risk of developing Lhermitte's sign (LS) in patients with lymphoma treated with modern-era chemotherapy followed by consolidation intensity-modulated radiation therapy.
  
  
  METHODS
  We prospectively interviewed all patients with lymphoma who received irradiation to the mediastinum from July 2011 through April 2014. We extracted patient, disease, and treatment-related variables from the medical records of those patients and dosimetric variables from treatment-planning systems and analyzed these factors to identify potential predictors of LS with Pearson chi-square tests.
  
  
  RESULTS
  During the study period 106 patients received mediastinal radiation for lymphoma, and 31 (29 %) developed LS. No correlations were found between LS and any of the variables examined, including total radiation dose, maximum point dose to the spinal cord, volume receiving 105 % of the dose, and volumes receiving 5 or 15 Gy.
  
  
  CONCLUSIONS
  In this group of patients, treatment with chemotherapy followed by intensity-modulated radiation therapy led to 29 % developing LS; this symptom was independent of radiation dose and seemed to be an idiosyncratic reaction. This relatively high incidence could have resulted from prospective use of a structured interview.
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. by04@aub.edu.lb.
authors.forename: Bassem
authors.initials: B
authors.lastname: Youssef
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. JHShank@mdanderson.org.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Shank
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. JReddy@mdanderson.org.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Reddy
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. CCPinnix@mdanderson.org.
authors.forename: Chelsea C
authors.initials: CC
authors.lastname: Pinnix
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. gfarha@mdanderson.org.
authors.forename: George
authors.initials: G
authors.lastname: Farha
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. MAkhtari@mdanderson.org.|Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA. MAkhtari@mdanderson.org.
authors.forename: Mani
authors.initials: M
authors.lastname: Akhtari
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. pallen@mdanderson.org.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Departments of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. mfanale@mdanderson.org.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Fanale
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. jgarcia@mdanderson.org.
authors.forename: John A
authors.initials: JA
authors.lastname: Garcia
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. phorace@mdanderson.org.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Horace
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. samilgrom@mdanderson.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Milgrom
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. glsmith@mdanderson.org.
authors.forename: Grace Li
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Departments of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ynieto@mdanderson.org.
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. iarzu@mdanderson.org.
authors.forename: Isadora
authors.initials: I
authors.lastname: Arzu
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. hewang@mdanderson.org.
authors.forename: He
authors.initials: H
authors.lastname: Wang
authors.affiliation: Departments of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. nfowler@mdanderson.org.
authors.forename: Nathan
authors.initials: N
authors.lastname: Fowler
authors.affiliation: Departments of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. marodriguez@mdanderson.org.
authors.forename: Maria Alma
authors.initials: MA
authors.lastname: Rodriguez
authors.affiliation: Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. bdabaja@mdanderson.org.
authors.forename: Bouthaina
authors.initials: B
authors.lastname: Dabaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008223:Lymphoma / Q000532:radiotherapy*; D008297:Male; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D013116:Spinal Cord / Q000528:radiation effects*; D055815:Young Adult