Lhermitte's sign: Incidence and treatment variables influencing risk after irradiation of the cervical spinal cord

Journal Article · Wed Dec 01 04:00:00 EST 1993 · International Journal of Radiation Oncology, Biology and Physics; (United States)

DOI:https://doi.org/10.1016/0360-3016(93)90519-2· OSTI ID:6582033

Fein, D A; Marcus, Jr, R B; Parsons, J T; Mendenhall, W M; Million, R R ^[1]

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1. Univ. of Florida, Gainesville, FL (United States)

Lhermitte's sign is a relatively infrequent sequela of irradiation of the cervical spinal cord. In this study, the authors sought to determine whether various treatment parameters influenced the likelihood of developing Lhermitte's sign. Between October 1964 and December 1987, 2901 patients with malignancies of the upper respiratory tract were treated at the University of Florida. The dose of radiation to the cervical spinal cord was calculated for those patients who had a minimum 1-year follow-up. A total of 1112 patients who received a minimum of 3000 cGy to at least 2 cm of cervical spinal cord were included in this analysis. Forty patients (3.6%) developed Lhermitte's sign. The mean time to development of Lhermitte's sign after irradiation was 3 months, and the mean duration of symptoms was 6 months. No patient with Lhermitte's sign developed transverse myelitis. Several variables were examined in a univariate analysis, including total dose to the cervical spinal cord, length of cervical spinal cord irradiated, dose per fraction, continuous-course compared with split-course radiotherapy, and once-daily compared with twice-daily irradiation. Only two variables proved to be significant. Six (8%) of 75 patients who received > 5000 cGy to the cervical spinal cord developed Lhermitte's sign compared with 34 (3.3%) of 1037 patients who received < 5000 cGy (p = .04). For patients treated with once-daily fractionation, 28 (3.4%) of 821 patients who received < 200 cGy per fraction developed Lhermitte's sign compared with 6 (10%) of 58 patients who received [ge] 200 cGy (p = .02). An increased risk of developing Lhermitte's sign was demonstrated for patients who received either [ge] 200 cGy per fraction (one fraction per day) or [ge] 5000 cGy total dose to the cervical spinal cord. 29 refs., 1 fig., 5 tabs.

• OSTI ID: 6582033
• Journal Information: International Journal of Radiation Oncology, Biology and Physics; (United States), Journal Name: International Journal of Radiation Oncology, Biology and Physics; (United States) Vol. 27:5; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

550603 -- Medicine-- External Radiation in Therapy-- (1980-)
560151* -- Radiation Effects on Animals-- Man
62 RADIOLOGY AND NUCLEAR MEDICINE
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
BIOLOGICAL EFFECTS
BIOLOGICAL RADIATION EFFECTS
CENTRAL NERVOUS SYSTEM
DOSE-RESPONSE RELATIONSHIPS
DOSES
FRACTIONATED IRRADIATION
IRRADIATION
MEDICINE
NERVOUS SYSTEM
NUCLEAR MEDICINE
RADIATION DOSES
RADIATION EFFECTS
RADIOLOGY
RADIOTHERAPY
SIDE EFFECTS
SPINAL CORD
THERAPY