Neurologic Complications After Irradiation of the Cervical Spinal Cord for Malignant Tumour of the Head and Neck

Serious, irreversible transverse lesions of the cervical spinal cord after irradiation of tumours in the head and neck have been reported (AHLBOM 1941, BODEN 1948, JACOBSSON 1951, VAETH 1965, VAN DEN BRENK et coll.1968).Neurologic deficits developed as a result of radiation myelitis in 103 out of 4 365 patients from 15 treatment series who had received irradiation of the cervical, thoracic or lumbar spinal cord (survey by PALMER 1972).In addition to transverse spinal lesions milder transient neurologic symptoms such as parasthesias and weakness of the extremities were also reported.Taken together, the total incidence for mild and severe complications was 2.4 per cent.The total dose to the spinal cord, the treatment time, and the area of the field are some of the physical factors of significance in the development of radiation myelitis.There is, however, no agreement regarding the significance of the dose-time relation (BODEN, VAETH) or of the treatment volume (PALLIS et coll.1961, JONES 1964).A review of the available reports reveals that in the majority of cases radiation myelitis occurs in patients treated with very high doses, with large doses over a short period, with large fields, or with an irradiation technique that produces a 'hot spot' in the spinal cord.