Neurobehavioral toxicity of total body irradiation: a follow-up in long-term survivors

Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):303-11. doi: 10.1016/s0360-3016(99)00442-3.


Purpose: Total body irradiation (TBI) in preparation for bone marrow transplantation (BMT) is a routine treatment of hematological malignancy. A retrospective and a prospective group study of long-term cerebral side effects was performed, with a special emphasis on neurobehavioral toxicity effects.

Methods and materials: Twenty disease-free patients treated with hyperfractionated TBI (14.4 Gy, 12 x 1.2 Gy, 4 days), 50 mg/kg cyclophosphamide, and autologous BMT (mean age 38 years, range 17-52 years; age at TBI 35 years, 16-50 years; follow-up time 32 months, 9-65 months) participated in a neuropsychological, neuroradiological, and neurological examination. Data were compared to 14 patients who were investigated prior to TBI. Eleven patients with renal insufficiencies matched for sex and age (38 years, 20-52 years) served as controls. In a longitudinal approach, neuropsychological follow-up data were assessed in 12 long-term survivors (45 years, 23-59 years; follow-up time 8.8 years, 7-10.8 years; time since diagnosis 10.1 years, 7.5-14.2 years).

Results: No evidence of neurological deficits was found in post-TBI patients except one case of peripheral movement disorder of unknown origin. Some patients showed moderate brain atrophy. Neuropsychological assessment showed a subtle reduction of memory performance of about one standard deviation. Cognitive decline in individual patients appeared to be associated with pretreatment (brain irradiation, intrathecal methotrexate). Ten-years post disease onset, survivors without pretreatment showed behavioral improvement up to the premorbid level.

Conclusion: The incidence of long-term neurobehavioral toxicity was very low for the present TBI/BMT regimen.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Affect / radiation effects
  • Atrophy
  • Behavior / radiation effects
  • Brain / pathology
  • Brain / radiation effects*
  • Cognition / radiation effects*
  • Cross-Sectional Studies
  • Dose Fractionation, Radiation
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Memory / radiation effects*
  • Middle Aged
  • Neuropsychological Tests
  • Peripheral Nervous System Diseases / diagnosis
  • Peripheral Nervous System Diseases / etiology
  • Prospective Studies
  • Retrospective Studies
  • Survivors
  • Transplantation Conditioning
  • Whole-Body Irradiation / adverse effects*