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| Format: | Recurso digital |
| Language: | English |
| Published: |
Zenodo
2026
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| Subjects: | |
| Online Access: | https://doi.org/10.5281/zenodo.18465185 |
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Table of Contents:
- <p>Radiation therapy is a cornerstone treatment for various types of tumors, including those in the nervous system. It uses high-energy rays or particles to destroy or damage cancer cells while attempting to spare surrounding healthy tissues. Depending on the tumor’s location and type, radiation therapy can be broadly applied to larger areas like the brain or precisely targeted at smaller, well-defined tumors using techniques such as stereotactic radiosurgery. Advances in medical technology have made radiation therapy more precise, but some risk to the nervous system remains unavoidable. Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications. Radiation therapy for nervous system tumors can lead to neurological damage, manifesting as acute, early-delayed, and late-delayed symptoms, with varying degrees of severity and impact on quality of life. The degree of neurological damage depends on factors such as the total radiation dose, the duration of treatment, the dose per session, and individual patient characteristics, including age, genetic predisposition, and overall health. For instance, children are more vulnerable to long-term effects due to the developing nature of their nervous systems, while older adults may face increased risks due to preexisting health conditions. Early-delayed effects typically appear weeks to a few months after the initiation of radiation therapy. These symptoms are generally mild and temporary, including: fatigue; ersisting tiredness, even after rest, can impact daily activities, headaches; recurring headaches may signal ongoing swelling or irritation in the brain, nausea; often linked to the continued healing process or residual swelling. In children undergoing whole-brain radiation, early-delayed symptoms can be more pronounced but often subside over time. Corticosteroids can help manage these symptoms, and physical therapy may be introduced to address any emerging motor coordination issues. Late-delayed effects are the most concerning as they occur months or even years after treatment, potentially causing permanent neurological damage. These effects may include: cognitive decline; issues with memory, attention, and problem-solving abilities, personality changes; mood swings, depression, or reduced emotional resilience, motor coordination problems; difficulty with balance or fine motor tasks, spinal cord damage; radiation near the spine may cause late-delayed myelopathy, resulting in sensory loss, muscle weakness, and Lhermitte sign (a shock-like sensation along the spine when bending the neck forward). Children treated for medulloblastoma or other brain tumors are particularly at risk for these effects due to their higher sensitivity to radiation. Long-term cognitive rehabilitation and regular neurological assessments are essential for managing these complications. Neurologic complications can be seen throughout the course of cancer diagnosis and treatment; some toxicities may not develop for years or even decades after completion of treatment, making diagnosis challenging. However, early recognition is critical as modification of therapeutic regimens can diminish long-term consequences of nervous system injury and improve a patient’s quality of life. Neoadjuvant therapy consisting of either chemotherapy, radiotherapy or immunotherapy is associated with toxic effects on different organ systems. Before surgery, a comprehensive neurological examination should be performed and documented in patients suspected of having neurotoxicity. In patients with peripheral neuropathy, attention should be paid to autonomic dysregulation, as this might lead to orthostatic hypotension. The use of regional anaesthesia is not contraindicated, but pre-existing neurological abnormalities should be documented. Because there is a wide variety of ICIs, the anaesthetist should pay attention to specific agents and toxicities.</p>