TY - JOUR
T1 - Tolerance of peripheral nerve to intraoperative radiotherapy (IORT)
T2 - Clinical and experimental studies
AU - Kinsella, Timothy J.
AU - Sindelar, William F.
AU - DeLuca, Anne Marie
AU - Pezeshkpour, G.
AU - Smith, Rosalie
AU - Maher, Michelle
AU - Terrill, Richard
AU - Miller, Robert
AU - Mixon, Arnold
AU - Harwell, James F.
AU - Rosenberg, Steven A.
AU - Glatstein, Eli
PY - 1985/9
Y1 - 1985/9
N2 - In our clinical experience combining wide excision and intraoperative radiotherapy (IORT), five patients have developed clinical signs of lumbosacral or sciatic neuropathy within 9 months of receiving IORT to a dose of 20-25 Gy. Three patients showed recovery of nerve function over several months while two patients have shown no recovery and have near complete loss of extremity function. In an attempt to investigate this clinical observation further, the lumbosacral plexus and sciatic nerve of American foxhounds were surgically exposed and received a single dose of IORT ranging from 20-75 Gy. An approximate linear relationship between radiation dose and time to onset of hind limb paresis is found with 19 of 21 irradiated dogs showing clinical signs of nerve injury within an interval of 1-19 months. No recovery of nerve function is seen in these dogs. Histological study of the irradiated nerves demonstrates a loss of nerve fibers, particularly those of the large myelinated type without evidence of vascular occlusion or thrombosis. These studies suggest that peripheral nerve may be a dose-limiting normal tissue in clinical studies of IORT.
AB - In our clinical experience combining wide excision and intraoperative radiotherapy (IORT), five patients have developed clinical signs of lumbosacral or sciatic neuropathy within 9 months of receiving IORT to a dose of 20-25 Gy. Three patients showed recovery of nerve function over several months while two patients have shown no recovery and have near complete loss of extremity function. In an attempt to investigate this clinical observation further, the lumbosacral plexus and sciatic nerve of American foxhounds were surgically exposed and received a single dose of IORT ranging from 20-75 Gy. An approximate linear relationship between radiation dose and time to onset of hind limb paresis is found with 19 of 21 irradiated dogs showing clinical signs of nerve injury within an interval of 1-19 months. No recovery of nerve function is seen in these dogs. Histological study of the irradiated nerves demonstrates a loss of nerve fibers, particularly those of the large myelinated type without evidence of vascular occlusion or thrombosis. These studies suggest that peripheral nerve may be a dose-limiting normal tissue in clinical studies of IORT.
KW - Intraoperative radiotherapy
KW - Peripheral nerve injury
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U2 - 10.1016/0360-3016(85)90209-3
DO - 10.1016/0360-3016(85)90209-3
M3 - Article
C2 - 4030429
AN - SCOPUS:0022364147
SN - 0360-3016
VL - 11
SP - 1579
EP - 1585
JO - International journal of radiation oncology, biology, physics
JF - International journal of radiation oncology, biology, physics
IS - 9
ER -