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Myeloma – RILP, CIPN, Myelopathy?

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After radiation therapy for tumors near the spine, late-delayed myelopathy may develop. This disorder causes weakness, loss of sensation, and sometimes the Brown-Séquard syndrome

The hallmark symptom of my multiple myeloma (MM) diagnosis in 2/94 was bone involvement causing pain, tingling and numbness in various parts of my body. Radiation (RAD) for multiple myeloma was my primary therapy.

At this point in my survival, I really don’t know if I live with:

  • chemotherapy-induced peripheral neuropathy (CIPN),
  • radiation-induced lumbo-sacral plexopathy (RIPN),
  • myelopathy
  • or a combination of all three.

I suppose determining a name for my side effect isn’t that big a deal. I have spent years trying to understand the damage done in hopes of figuring out how to heal that damage…

I underwent two courses of radiation therapy to my spine. In March of 1994 a single bone plasmacytoma (MM) necessitated  4400 Gy of radiation to my C5 area. Then again about 13 months later I had another 3000 Gy to my sacrum. I live with symptoms of  several different side effects-

  • radiation-induced lumbo-sacral plexopathy
  • chemotherapy-induced peripheral neuropathy
  • late-stage myelopathy
  • and Brown-Sequard syndrome

The point of this post is to highlight radiation as a problematic therapy for multiple myeloma patients and survivors. Radiation to and around the spine causes all sorts of long-term damage. And the frustrating aspect of this sort of damage is that it can be realized only after months and/or years.

Keep in mind that radiation to my spine was a palliative therapy for my multiple myeloma. Though my oncologist never discussed this with me, Dr. Berger was well aware that this therapy benefit was temporary at best.

If you had seen me walking around in ’96-’99 you would not have guessed I suffered any radiation damage. Skip ahead to today, August of 2019 and I can walk only with the use of hiking poles.

Possible therapies to minimize or prevent damage from my radiation therapy would have been

All of these evidence-based, non-toxic therapies have been shown to reduce damage from radiation.

David Emerson

  • Multiple Myeloma Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

[Radiation myelopathy and plexopathy]

“Radiation myelopathy (RM) is a relatively rare disorder characterized by white matter lesions of the spinal cord resulting from irradiation. It is divided into two forms by the latent periods: transient RM and delayed RM.

The delayed RM develops usually non-transverse myelopathy symptoms such as dissociated sensory disturbance, unilateral leg weakness, and gait disturbance with asymmetric steps.

Spinal MRI shows initially cord swelling and long T1/T2 intramedullary lesion with enhancement, then exhibits cord atrophy. Histopathological findings of delayed RM are white matter necrosis, demyelination, venous wall thickening and hyalinization. Glial theory and vascular hypothesis have been proposed to explain its pathophysiology.

Several therapies such as:

  • adrenocorticosteroid,
  • anticoagulation and
  • hyperbaric oxygen

have been tried to this disease with variable benefits.

Radiation plexopathy is classified into two major types by the location: radiation-induced brachial plexopathy (BP) and radiation-induced lumbosacral plexopathy (RILP).

The BP initially emerges as arm and shoulder pain, whereas RILP as leg weakness. Myokymia and fasciculations are observed in both types.

Electrophysiological study reveals findings of peripheral neuropathy. It is often difficult to distinguish the radiation plexopathy from cancer invasion to the plexus, but MRI is useful to differentiate between these diseases.

Pathological findings are small vessel obstruction, thick fibrosis, axonal degeneration and demyelination. Its pathomechanism is presumed that radiation-induced fibrous tissue compresses the nerve root as well as microvascular obstruction of the nerve. Adrenocorticosteroid and anticoagulation are considered as the strategy for symptomatic relief.

Damage to the Nervous System Due to Radiation Therapy

“Radiation therapy is one component in the treatment of tumors of the nervous system. It is directed at the general area (such as the whole head) when people have several tumors or a tumor that does not have distinct borders. When the tumor has distinct borders, therapy can be directed specifically at the tumor.

Radiation from these treatments sometimes damages the nervous system, despite the best efforts to prevent damage (see Overview of Imaging Tests : Risks of Radiation in Medical Imaging).

Whether damage occurs and how severe it is depend on several factors:

  • How much RAD is given over the entire course of treatment (total cumulative dose)
  • How much RAD is given in each dose
  • How long the treatments are given
  • How much of the nervous system is exposed to RAD
  • How susceptible the person is

Symptoms of radiation damage can develop in the first few days (acute) or months of treatment (early-delayed) or several months or years after treatment (late-delayed). Symptoms can remain the same or worsen and can be temporary or permanent…

If RAD is directed at the spine in the neck or upper back, early-delayed radiation myelopathy may develop. This disorder sometimes causes a sensation similar to an electric shock. The sensation begins in the neck or back, usually when the neck is bent forward, and shoots down to the legs. This disorder usually resolves without treatment.

Late-delayed RAD damage causes symptoms many months or years after RAD therapy. Many children and adults who receive whole-head brain RAD therapy develop late-delayed toxicity if they survive long enough. The most common cause in children is RAD therapy to prevent leukemia or to treat a type of brain tumor called medulloblastoma. Symptoms include progressively worsening dementia, memory loss, difficulty thinking, mistaken perceptions, personality changes, and, in adults, unsteadiness in walking.

After RAD therapy for tumors near the spine, late-delayed myelopathy may develop. This disorder causes weakness, loss of sensation, and sometimes the Brown-Séquard syndrome. In this syndrome, one side of the spinal cord is damaged, resulting in weakness on one side of the body and loss of pain and temperature sensation on the other side.

On the weak side of the body, people may be unable to sense where their hands and feet are without looking at them (position sense). Late-delayed radiation myelopathy usually does not subside and often results in paralysis.

Nerves near the site of the RAD therapy may also be damaged. For example, RAD to a breast or lung may damage nerves in the arms, and RAD to the groin may damage nerves in the legs. Weakness or loss of sensation may result.”


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