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COMPLICATIONS OF RADIATION THERAPY is a topic covered in the Harrison's Manual of Medicine.

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Three patterns of radiation injury after CNS RT:

  1. Acute: headache, sleepiness, worse neurologic deficits during or immediately after RT. Rarely seen with current protocols. Can be both prevented and treated with glucocorticoids.
  2. Early delayed: somnolence (children), Lhermitte’s sign; within weeks to months of RT. Increased T2 signal and sometimes enhancement on MRI that can mimic tumor recurrence (“pseudoprogression”). Self-limited and improves with glucocorticoids; if very symptomatic may require resection.
  3. Late delayed: dementia or other progressive neurologic deficits; typically months to years after RT. White matter abnormalities on MRI (leukoencephalopathy) or ring-enhancing mass (radiation necrosis). PET can distinguish delayed necrosis from tumor recurrence as can MR perfusion sequences. Progressive radiation necrosis is best treated palliatively with surgical resection unless it can be managed with glucocorticoids. Radiation injury of large arteries accelerates the development of atherosclerosis, increasing the risk of stroke years after RT. Endocrine dysfunction due to hypothalamus or pituitary gland injury can be due to delayed effects of RT. Development of a second neoplasm after RT also is a risk year after exposure.

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Loscalzo, Joseph, et al., editors. "COMPLICATIONS of RADIATION THERAPY." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623479/all/COMPLICATIONS_OF_RADIATION_THERAPY.
COMPLICATIONS OF RADIATION THERAPY. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623479/all/COMPLICATIONS_OF_RADIATION_THERAPY. Accessed April 23, 2019.
COMPLICATIONS OF RADIATION THERAPY. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623479/all/COMPLICATIONS_OF_RADIATION_THERAPY
COMPLICATIONS of RADIATION THERAPY [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 23]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623479/all/COMPLICATIONS_OF_RADIATION_THERAPY.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - COMPLICATIONS OF RADIATION THERAPY ID - 623479 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623479/all/COMPLICATIONS_OF_RADIATION_THERAPY PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -