Antineoplastics
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Reactions 1283 - 9 Jan 2010 S Antineoplastics Ascending myelitis in patients receiving radiotherapy: 3 case reports A retrospective study identified three adolescents receiving radiotherapy (RT) who developed ascending myelitis associated with intrathecal (methotrexate, cytarabine and hydrocortisone) and systemic (vincristine, dactinomycin and cyclophosphamide) chemotherapy. The three adolescents had paraspinal primaries, and presented with symptoms of spinal chord impingement [see table for patient characteristics]; however, spinal cord symptoms resolved following RT and initial surgery, before the onset of treatment-related myelopathy. All patients were treated according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) II-26 regimen. They received RT; systemic chemotherapy with vincristine, dactinomycin and cyclophosphamide [dosages not stated]; and intrathecal chemotherapy with methotrexate, cytarabine and hydrocortisone [see table for dosage information]. Time from therapy initiation to symptom onset was 4 months in patient 3, and was ‘uncertain’ for the remaining two patients. Patient 3 became paretic in her upper extremities, paraplegic, and incontinent of bladder and bowel function. [Treatments and patient outcomes not stated]. Author comment: "Paralyzing ascending myelitis associated with treatment of tumors located within or in proximity to the CNS can result from chemotherapy, RT, or both. . . Simultaneous administration of RT and chemotherapy may reduce spinal cord radiation tolerance". Patient characteristics Patient/ Underlying Intrathecal chemotherapy × sex/age condition number of doses 1/F a /13 Rhabdomyosarcoma Methotrexate 15 mg/m 2 × 3, cytarabine 60 mg/m 2 × 3, hydrocortisone 30 mg/m 2 × 3 2/M a /16 Rhabdomyosarcoma Methotrexate 15 mg/m 2 × 3, cytarabine 60 mg/m 2 × 3, hydrocortisone 30 mg/m 2 × 3 3/F/13 Extra osseous Methotrexate 12 mg/m 2 × 5, Ewing cytarabine 50 mg/m 2 × 4, sarcoma/ hydrocortisone 50 mg/m 2 × 5 primitive neuroectodermal tumour a Sex uncertain from available records Bleyer A, et al. Increased vulnerability of the spinal cord to radiation or intrathecal chemotherapy during adolescence: a report from the Children’s Oncology Group. Pediatric Blood and Cancer 53: 1205-1210, No. 7, 15 Dec 2009 - USA 801158130 1 Reactions 9 Jan 2010 No. 1283 0114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1283 - 9 Jan 2010
SAntineoplastics
Ascending myelitis in patients receivingradiotherapy: 3 case reports
A retrospective study identified three adolescentsreceiving radiotherapy (RT) who developed ascendingmyelitis associated with intrathecal (methotrexate,cytarabine and hydrocortisone) and systemic (vincristine,dactinomycin and cyclophosphamide) chemotherapy.
The three adolescents had paraspinal primaries, andpresented with symptoms of spinal chord impingement[see table for patient characteristics]; however, spinal cordsymptoms resolved following RT and initial surgery, beforethe onset of treatment-related myelopathy. All patientswere treated according to the IntergroupRhabdomyosarcoma Study Group (IRSG) II-26 regimen.They received RT; systemic chemotherapy with vincristine,dactinomycin and cyclophosphamide [dosages not stated];and intrathecal chemotherapy with methotrexate,cytarabine and hydrocortisone [see table for dosageinformation]. Time from therapy initiation to symptomonset was 4 months in patient 3, and was ‘uncertain’ for theremaining two patients. Patient 3 became paretic in herupper extremities, paraplegic, and incontinent of bladderand bowel function. [Treatments and patient outcomes notstated].
Author comment: "Paralyzing ascending myelitisassociated with treatment of tumors located within or inproximity to the CNS can result from chemotherapy, RT, orboth. . . Simultaneous administration of RT andchemotherapy may reduce spinal cord radiation tolerance".
Patient characteristicsPatient/ Underlying Intrathecal chemotherapy ×sex/age condition number of doses
1/Fa/13 Rhabdomyosarcoma Methotrexate 15 mg/m2 × 3,cytarabine 60 mg/m2 × 3,
hydrocortisone 30 mg/m2 × 32/Ma/16 Rhabdomyosarcoma Methotrexate 15 mg/m2 × 3,
cytarabine 60 mg/m2 × 3,hydrocortisone 30 mg/m2 × 3
3/F/13 Extra osseous Methotrexate 12 mg/m2 × 5,Ewing cytarabine 50 mg/m2 × 4,
sarcoma/ hydrocortisone 50 mg/m2 × 5primitive
neuroectodermaltumour
a Sex uncertain from available records
Bleyer A, et al. Increased vulnerability of the spinal cord to radiation or intrathecalchemotherapy during adolescence: a report from the Children’s Oncology Group.Pediatric Blood and Cancer 53: 1205-1210, No. 7, 15 Dec 2009 -USA 801158130
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Reactions 9 Jan 2010 No. 12830114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
