Encyclopedia of Clinical Neuropsychology

2018 Edition
| Editors: Jeffrey S. Kreutzer, John DeLuca, Bruce Caplan

Early-Delayed Effects of Radiation

  • Carol L. ArmstrongEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-319-57111-9_105


Subacute radiotherapy effects


Therapeutic ionizing irradiation (RT) affects the nervous system in different biological settings and with different mechanisms that manifest at different time points. The early-delayed phase of RT, also termed subacute, is observed weeks to months after treatment is completed (measured 2–4 months post completion of RT but as early as 2 weeks), whether RT is given alone or combined with chemotherapy. The cognitive effects are transient, and if reversal of symptoms does not occur within weeks to months after treatment is completed, a change in neoplastic process should be considered. In more severe cases, symptoms may be similar to those of the tumor, such as headache, lethargy, and worsening of lateralizing signs. Cognition is affected, but effects are thought to be mild and temporary (Rottenberg 1991; Armstrong et al. 2012), and thus reverse again. L’hermitte’s syndrome sometimes occurs following spinal RT and is thought to be due to...

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References and Readings

  1. Ahles, T., Silberfarb, P., Herndon, J., Maurer, L., Kornblith, A., Aisner, J., et al. (1998). Psychological and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: A study by the Cancer and Leukemia Group C. Journal of Clinical Oncology, 16, 1954–1960.PubMedCrossRefPubMedCentralGoogle Scholar
  2. Armstrong, C., Corn, B., Ruffer, J., Pruitt, A., Mollman, J., & Phillips, P. (2000). Radiotherapeutic effects on brain function: Double dissociation of memory systems. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 13, 101–111.Google Scholar
  3. Armstrong, C., Stern, C., Ruffer, J., & Corn, B. (2001). Memory performance used to detect radiation effects on cognitive functioning. Applied Neuropsychology, 8(3), 129–139.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Armstrong, C. L., Hampstead, B., & Guglielmi, L. (2004). Hippocampal response to neuro-oncological stressors [abstract]. Journal of the International Neuropsychological Society, 10(S1), 65.Google Scholar
  5. Armstrong, C. L., Hunter, J. V., Hackney, D., Shabbout, M., Lustig, R., Goldstein, B., et al. (2005). MRI changes during the early-delayed phase of radiotherapy effects. International Journal of Radiation Oncology, Biology, and Physics, 63(1), 56–63.CrossRefGoogle Scholar
  6. Armstrong, C. L., Shera, D. M., Lustig, R. A., & Phillips, P. C. (2012). Phase measurement of cognitive impairment specific to radiotherapy. International Journal of Radiation Oncology, Biology, and Physics, 83(3), e319–e324.CrossRefGoogle Scholar
  7. Armstrong, C. L., Fisher, M. J., Li, Y., Lustig, R. A., Belasco, J. B., Minturn, J. E., et al. (2016). Neuroplastic response after radiation therapy for pediatric brain tumors: A pilot study. International Journal of Radiation Oncology, Biology, and Physics, 95(3), 991–998.CrossRefGoogle Scholar
  8. Corn, B., Yousem, D., Scott, C., Rotman, M., Asbell, S., Nelson, D., et al. (1994). White matter changes are correlated significantly with radiation dose. Cancer, 74, 2828–2835.PubMedCrossRefPubMedCentralGoogle Scholar
  9. DeAngelis, L., Delattre, J.-Y., & Posner, J. (2001). Neurological complications of chemotherapy and radiation therapy. In M. Aminoff (Ed.), Neurology and general medicine (3rd ed., pp. 437–458). Philadelphia: Churchill-Livingstone.Google Scholar
  10. Di Pinto, M., Conklin, H. M., Li, C., et al. (2010). Investigating verbal and visual auditory learning after conformal radiation therapy for childhood ependymoma. International Journal of Radiation Oncology, Biology, and Physics, 77, 1002–1008.CrossRefGoogle Scholar
  11. Di Pinto, M., Conklin, H. M., Li, C., & Merchant, T. E. (2012). Learning and memory following conformal radiation therapy for pediatric craniopharyngioma and low-grade glioma. International Journal of Radiation Oncology, Biology, and Physics, 84, e363–e369.CrossRefGoogle Scholar
  12. Dunbar, S., & Loeffler, J. (1994). Stereotactic radiation therapy. In P. Mauch & J. Leoffler (Eds.), Radiation oncology: Technology and biology (pp. 237–251). Philadelphia: WB Saunders.Google Scholar
  13. Fouladi, M., Wallace, D., Langston, J. W., et al. (2003). Survival and functional outcome of children with hypothalamic/chiasmatic tumors. Cancer, 97, 1084–1092.PubMedCrossRefPubMedCentralGoogle Scholar
  14. Llanes, S., Torres, I. J., Roeske, A., Mundt, S., Keedy, S., & Zakowski, S. (2004). Temporal lobe radiation and memory in adult brain tumor patients. Journal of the International Neuropsychological Society, 10(S1), 185.Google Scholar
  15. Merchant, T. E., Kiehna, E. N., Chenghong, L., et al. (2005). Radiation dosimetry predicts IQ after conformal radiation therapy in pediatric patients with localized ependymoma. International Journal of Radiation Oncology, Biology, and Physics, 63, 1546–1554.CrossRefGoogle Scholar
  16. Monje, M. L., & Palmer, T. (2003). Radiation injury and neurogenesis. Current Opinion in Neurology, 16, 129–134.CrossRefGoogle Scholar
  17. Monje, M. L., Mizumatsu, S., Fike, S., & Palmer, T. D. (2002). Irradiation induces neural precursor-cell dysfunction. Nature Medicine, 8(9), 955–962.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Nagel, B. J., Palmer, S. L., Reddick, W. E., Glass, J. O., Helton, K. J., Wu, S. J., et al. (2004). Abnormal hippocampal development in children with medulloblastoma treated with risk-adapted irradiation. American Journal of Neuroradiology, 25, 1575–1582.PubMedPubMedCentralGoogle Scholar
  19. Palmer, S. L., Armstrong, C. L., Onar-Thomas, A., et al. (2013). Processing speed, attention and working memory after treatment for medulloblastoma: An international, prospective and longitudinal study. Journal of Clinical Oncology, 31, 3494–3500.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Phillips, P., Delattre, J., Berger, C., & Rottenberg, D. (1987). Early and progressive increase in regional brain capillary permeability following single and fractionated dose cranial irradiation in the rat (abstr.) Neurology, 37(Suppl. 1), 301.Google Scholar
  21. Radcliffe, J., Bunin, G., Sutton, L., et al. (1994). Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: Age-dependent effects of whole brain radiation. International Journal of Developmental Neuroscience, 12, 327–334.CrossRefGoogle Scholar
  22. Reimers, T. S., Ehrenfels, S., Mortensen, E. L., et al. (2003). Cognitive deficits in long-term survivors of childhood brain tumors: Identification of predictive factors. Medical and Pediatric Oncology, 40, 26–34.PubMedCrossRefPubMedCentralGoogle Scholar
  23. Rottenberg, D. (1991). Acute and chronic effects of radiation therapy on the nervous system. In D. Rottenberg (Ed.), Neurological complications of cancer treatment (pp. 3–17). Boston: Butterworths.Google Scholar
  24. Shaw, E. G., & Robbins, M. E. (2008). Biological bases of radiation injury to the brain. In C. A. Meyers & J. R. Perry (Eds.), Cognition and cancer (pp. 83–96). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  25. Vigliani, M., Sichez, N., Poisson, M., & Delattre, J. (1996). A prospective study of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4-Year results. International Journal of Radiation Oncology, Biology, and Physics, 35, 527–533.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Child and Adolescent Psychiatry and Behavioral SciencesThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA