Eight years after a gamma-therapy for a malign tumor of the right tonsil, symptoms of a myelitis appeared. Pain and weakness of the right arm and leg and non-apparent neurological signs on the right part of the head were evident. No other signs of any tumor or damage of the vertebra as evaluated with tomography.
First you should discard other non-oncological diseases (endocrinological and neurological among them). A RM is also compulsory, CT-scans alone did'nt offer a proper neurological image.
If all test are negative, then you could asume to be RT toxicity. In such case no treatment has been described. You could try vit B, tocopherol, pentoxifylline.
Unilateral symptoms (arm, leg and head) are quite unusual for a radiation induced myelitis.
Brain and medullar MRI are mandatory to eliminate another diagnosis.
Some therapeutic protocols have proven an efficacy (but with a relatively low level of evidence) but more in the clinical settings of plexopathy (the PENTOCLO association of 3 drugs: pentoxifylline, tocopherol and clodrontate).
Example of a publication:
" J Neurol Sci. 2008 Dec 15;275(1-2):164-6. doi: 10.1016/j.jns.2008.08.004. Epub 2008 Sep 19.
Significant clinical improvement in radiation-induced lumbosacral polyradiculopathy by a treatment combining pentoxifylline, tocopherol, and clodronate (Pentoclo).
Delanian S, Lefaix JL, Maisonobe T, Salachas F, Pradat PF.
Abstract
Radiation-induced (RI) peripheral neuropathy is a rare and severe delayed complication of radiotherapy that is spontaneously irreversible, with no standard of treatment. We previously developed a successful antioxidant treatment in RI fibrosis and necrosis. Two patients with progressive worsening RI lumbosacral polyradiculopathy experienced over several years a significant clinical improvement in their neurological sensorimotor symptoms with long-term pentoxifylline-tocopherol-clodronate treatment, and good safety."
To Dr. Sebastia Sabater and Dr. G. Louvel;
Thank You honorable Doctors. I am very grateful for Your valuable advises. This patient that I am speaking about is my father, so THANK YOU AGAIN! Radiotherapists here said they have not too much experience in these cases. Soon he will have an MRI but not yet defined the type of MRI (with or without contrast, I would be grateful to You if You have any advice).
For Dr. Louvel: Sorry if I were not too clear but the symptoms aren't present in head an neck.
RESPECTFULLY, Dr. Kastriot Mark Shytaj.
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