Acute complications of cranial irradiation
- Ari Ballonoff, MD
Ari Ballonoff, MD
- Attending Radiation Oncologist
- Colorado Permanente Medical Group
- Exempla Saint Joseph 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 the elderly 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
Acute side effects occurring during standard fractionated brain radiation using contemporary techniques are typically mild and manageable with basic supportive care. Some of the more common and uncommon toxicities are discussed below.
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- STANDARD FRACTIONATED RADIATION
- Common acute reactions
- - Fatigue
- - Nausea and vomiting
- - Radiation dermatitis and alopecia
- - Cerebral edema
- Uncommon acute reactions
- - Hearing problems
- - Myelosuppression
- - Mucositis
- - Parotitis
- - Acute encephalopathy
- Early-delayed reactions
- - Transient focal neurologic symptoms
- - Pseudoprogression
- - Somnolence syndrome
- STEREOTACTIC RADIOSURGERY
- Severe acute reactions
- Less severe acute reactions
- INFORMATION FOR PATIENTS