Table 1.
Toxicity outcomes among patients with multiple sclerosis treated with tumoricidal radiation doses
| Study | Number of study patients | Disease | Radiation therapy | Outcomes |
|---|---|---|---|---|
| Lampert (1959)5 | 1 | Basal cell carcinoma of external auditory canal | 57.5 Gy in 20 fractions | Obtundation, death 3 mo after treatment |
| McMeekin (1969)6 | 1 | Glomus jugulare tumor | 72 Gy in 45 fractions | Rapid neurologic deterioration within 2 mo of radiation, autopsy consistent with demyelinating injury in radiation field |
| Peterson (1993)7 | 5 | Demyelinating lesions (identified retrospectively as not tumors) | 40-60 Gy | 4/5 patients experienced unexpectedly poor neurologic outcome |
| Murphy (2003)8 | 1 | Metastatic adenoid cystic carcinoma | 50 Gy in 25 fractions | Clinical and radiographic findings consistent with acute multiple sclerosis exacerbation within 10 w of treatment |
| Miller (2006)9 | 15 | 9/15 primary brain tumors, 4/15 metastatic tumors, 2/15 retroactively found to be demyelinating lesions | 30-55.8 Gy (median 50 Gy) | Grade 4+ neurotoxicity in 6/15 patients at 1 y |
| Daniels (2009)10 | 1 | Pituitary adenoma | Gamma knife marginal dose 25 Gy | Optic neuritis within 3 mo of treatment |
| Lowell (2011)11 | 6 | 3 metastatic tumors, 3 primary tumors | Gamma knife marginal dose 12-21 Gy | 3/6 patients with grade 2 + toxicities: 6th nerve palsy (grade 2), 7th nerve palsy (grade 3), AMS/hydrocephalus/diffuse cerebral atrophy with leukoaraiosis (grade 3) |
| Milic (2016)21 | 2 | Oligodendroglioma | 56 Gy in 30 fractions | New onset white matter lesions consistent with acute demyelination 2 and 4 mo after treatment |
| Borges (2021)22 | 1 | Suprasellar germinoma | 24 Gy in 15 fractions (whole ventricular radiation) | Multiple white matter lesions in posterior fossa and supratentorium consistent with inflammatory lesions |
| Wallerius (2021)12 | 1 | Vestibular schwannoma | 25 Gy in 5 fractions | Grade 2 toxicity and radiation edema consistent with multiple sclerosis exacerbation |