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Cited by 653Effects of Radiation ExposureRadiation Therapy and DosimetryBrain Metastases and Treatment

Radiation response of the central nervous system

Schultheiss, T.E., Kun, L.E., Ang, K.K., Stephens, L.C.·1995·International Journal of Radiation Oncology*Biology*Physics
DOI 10.1016/0360-3016(94)00655-5
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Abstract

This report reviews the anatomical, pathophysiological, and clinical aspects of radiation injury to the central nervous system (CNS). Despite the lack of pathognomonic characteristics for CNS radiation lesions, demyelination and malacia are consistently the dominant morphological features of radiation myelopathy. In addition, cerebral atrophy is commonly observed in patients with neurological deficits related to chemotherapy and radiation, and neurocognitive deficits are associated with diffuse white matter changes. Clinical and experimental dose-response information have been evaluated and summarized into specific recommendations for the spinal cord and brain. The common spinal cord dose limit of 45 Gy in 22 to 25 fractions is conservative and can be relaxed if respecting this limit materially reduces the probability of tumor control. It is suggested that the 5% incidence of radiation myelopathy probably lies between 57 and 61 Gy to the spinal cord in the absence of dose modifying chemotherapy. A clinically detectable length effect for the spinal cord has not been observed. The effects of chemotherapy and altered fractionation are also discussed. Brain necrosis in adults is rarely noted below 60 Gy in conventional fractionation, with imaging and clinical changes being observed generally only above 50 Gy. However, neurocognitive effects are observed at lower doses, especially in children. A more pronounced volume effect is believed to exist in the brain than in the spinal cord. Tumor progression may be hard to distinguish from radiation and chemotherapy effects. Diffuse white matter injury can be attributed to radiation and associated with neurological deficits, but leukoencephalopathy is rarely observed in the absence of chemotherapy. Subjective, objective, management, and analytic (SOMA) parameters related to radiation spinal cord and brain injury have been developed and presented on ordinal scales.

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  • Ionizing radiation can damage the CNS, causing changes to cognitive function, inducing fatigue, and generating performance decrements.

    “Ionizing radiation can damage the CNS, causing changes to cognitive function, inducing fatigue, and generating performance decrements [2,30,42,43,44,45,46,47,48,49,50,51].”

    From Space Radiation: The number one risk to astronaut health beyond low earth orbit (2014) · cites this paper as [48]

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Authors
Schultheiss, T. E., Kun, L. E., Ang, K. K., & Stephens, L. C.
Affiliations
  • Fox Chase Cancer Center (US)
  • St. Jude Children's Research Hospital (US)
  • The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Schultheiss, T.E.
ORCID
Venue
International Journal of Radiation Oncology*Biology*Physics
Publisher
Elsevier BV
Published
1995-03
Volume
31
Issue
5
Pages
1093-1112
ISSN
0360-3016 (ISSN-L)
DOI
10.1016/0360-3016(94)00655-5
OpenAlex
W2069308124
Cited by
653
References
148
Citations by year
2026: 6 · 2025: 10 · 2024: 13 · 2023: 5 · 2022: 11 · 2021: 19 · 2020: 21 · 2019: 12 · 2018: 18 · 2017: 17 · 2016: 25 · 2015: 19 · 2014: 29 · 2013: 20 · 2012: 21
FWCI
4.50
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Radiation Oncology*Biology*Physics (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ca054295-04)
  • National Cancer Institute (CA54295)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Radiation Therapy and Dosimetry
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Brain Metastases and Treatment
Keywords
radiation injury, central nervous system, radiation myelopathy, brain necrosis, brain atrophy, demyelination, white matter injury, leukoencephalopathy, neurocognitive impairment, chemotherapy-induced neurotoxicity, altered fractionation, dose-response relationship, tumor control
MeSH terms
Animals, Blood Vessels, Brain, Humans, Morbidity, Radiation Dosage, Radiation Injuries, Radiation Tolerance, Severity of Illness Index, Spinal Cord, Spinal Cord Diseases, Injury Severity Score

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