Adverse radiation effects after radiosurgery may benefit from oral vitamin E and pentoxifylline therapy: a pilot study

Stereotact Funct Neurosurg. 2008;86(6):359-66. doi: 10.1159/000163557. Epub 2008 Oct 16.

Abstract

Background: Although uncommon, adverse radiation effects (ARE) are a potentially serious side effect of brain stereotactic radiosurgery (SRS). Corticosteroids are used to treat suspected ARE but side effects may be significant after long-term usage. Oral pentoxifylline (Ptx) and vitamin E therapy (VitE) are reported to benefit ARE seen in other organ systems. We treated 11 patients with suspected ARE after SRS with Ptx and VitE.

Methods: To assess the response, edema was measured using fluid-attenuated inversion recovery magnetic resonance imaging (MRI). Edema volumes were calculated by first determining the three maximum measurements in the X, Y, and Z planes of the image with the largest signal change. Volume was plotted over time for each patient that had serial MRI scans available. Two patients had 2 separate radiosurgeries and 2 patients underwent 3. Three patients received adjuvant whole-brain radiation therapy.

Results: The time until clinical detection of ARE after SRS varied from 3 to 18 months (median, 8 months). The change in edema volume varied from 59.6 ml in 1 patient (worse edema) to -324.2 ml (improvement). The average change in edema from pre- to post-treatment was -72.3 ml. One patient had more edema despite treatment; this patient was found to have tumor recurrence, and not an ARE. Two patients discontinued Ptx because of persistent nausea and abdominal discomfort.

Conclusions: Ptx and VitE may be of benefit in the management of adverse radiation effects and should be studied further.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Brain Edema / drug therapy
  • Brain Edema / etiology
  • Child
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pentoxifylline / administration & dosage*
  • Pentoxifylline / therapeutic use
  • Pilot Projects
  • Radiosurgery / adverse effects*
  • Tocopherols / administration & dosage*
  • Tocopherols / therapeutic use

Substances

  • Tocopherols
  • Pentoxifylline