Acute complications of cranial irradiation
- Helen A Shih, MD
Helen A Shih, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Attending Radiation Oncologist
- Massachusetts General Hospital
Cranial irradiation is used to treat patients with primary or metastatic brain tumors and as prophylaxis for selected patients at high risk of neoplastic involvement of the nervous system. A full understanding of the potential consequences associated with cranial irradiation is needed both to manage potential complications and to properly counsel patients and/or families prior to treatment.
The primary factors influencing the likelihood of developing complications include the volume of normal brain tissue treated, the total radiation dose, and the fractionation schedule. The likelihood of brain toxicity also increases in the young (ie, <5 years old) and in older adults and with use of concurrent or sequential chemotherapy. Poorly characterized genetic factors may also make certain individuals more susceptible to otherwise safe doses of radiation. (See "Delayed complications of cranial irradiation", section on 'Pathophysiology'.)
The complications of radiation therapy are usually divided into acute effects that can occur during radiation or up to six weeks afterwards, early-delayed effects that appear up to six months after radiation, and late effects that can develop six months or more after the completion of radiation. Unlike acute and early-delayed reactions that are usually reversible, late reactions are generally irreversible.
The acute complications of both standard fractionated cranial irradiation and stereotactic radiosurgery will be reviewed here. The late complications of cranial irradiation and complications of spinal cord and peripheral nerve irradiation are discussed elsewhere. (See "Delayed complications of cranial irradiation" and "Complications of spinal cord irradiation" and "Brachial plexus syndromes", section on 'Neoplastic and radiation-induced brachial plexopathy' and "Lumbosacral plexus syndromes", section on 'Radiation plexopathy'.)
STANDARD FRACTIONATED RADIATION THERAPY
Acute side effects occurring during standard fractionated brain radiation therapy (RT) using contemporary techniques are typically mild and manageable with basic supportive care. Some of the more common and uncommon toxicities are discussed below.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- STANDARD FRACTIONATED RADIATION THERAPY
- Common acute reactions
- - Fatigue
- - Loss of appetite
- - Radiation dermatitis and alopecia
- - Headaches
- - Nausea and vomiting
- - Worsening of preexisting neurologic symptoms
- Other acute reactions
- - Hearing problems
- - Parotitis
- Uncommon acute reactions
- - Acute encephalopathy
- Early-delayed reactions
- - Persistent fatigue
- - Transient focal neurologic symptoms
- - Pseudoprogression
- Late effects
- STEREOTACTIC RADIOSURGERY
- Severe acute reactions
- Less common acute reactions
- INFORMATION FOR PATIENTS