Adverse radiation effects after radiosurgery may benefit from oral vitamin E and pentoxifylline therapy: a pilot study.

Document Type

Article

Abstract

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.

Medical Subject Headings

Administration, Oral; Adolescent; Adult; Aged; Brain Edema; Child; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pentoxifylline; Pilot Projects; Radiosurgery; Tocopherols

Publication Date

1-1-2008

Publication Title

Stereotactic and functional neurosurgery

ISSN

1423-0372

Volume

86

Issue

6

First Page

359

Last Page

366

PubMed ID

18854663

Digital Object Identifier (DOI)

10.1159/000163557

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