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combination treatment promising for adverse radiation effects of stereotactic surgery
Adverse Radiation Effects after Radiosurgery May Benefit from Oral Vitamin E and Pentoxifylline Therapy: A Pilot Study.
Williamson R, Kondziolka D, Kanaan H, Lunsford LD, Flickinger JC.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pa., USA.
Background: Although uncommon, adverse radiation effects (ARE) are a potentially serious side effect of brain stereotactic radiosurgery (SRS). Corticosteroids are used to treat suspected ARE but side effects may be significant after long-term usage. Oral pentoxifylline (Ptx) and vitamin E therapy (VitE) are reported to benefit ARE seen in other organ systems. We treated 11 patients with suspected ARE after SRS with Ptx and VitE. Methods: To assess the response, edema was measured using fluid-attenuated inversion recovery magnetic resonance imaging (MRI). Edema volumes were calculated by first determining the three maximum measurements in the X, Y, and Z planes of the image with the largest signal change. Volume was plotted over time for each patient that had serial MRI scans available. Two patients had 2 separate radiosurgeries and 2 patients underwent 3. Three patients received adjuvant whole-brain radiation therapy. Results: The time until clinical detection of ARE after SRS varied from 3 to 18 months (median, 8 months). The change in edema volume varied from 59.6 ml in 1 patient (worse edema) to -324.2 ml (improvement). The average change in edema from pre- to post-treatment was -72.3 ml. One patient had more edema despite treatment; this patient was found to have tumor recurrence, and not an ARE. Two patients discontinued Ptx because of persistent nausea and abdominal discomfort. Conclusions: Ptx and VitE may be of benefit in the management of adverse radiation effects and should be studied further. Copyright © 2008 S. Karger AG, Basel.
PMID: 18854663
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Hybrid Mode
