Late neurological complications after irradiation of malignant tumors of the testis

Figures & data

Figure 1.

Table I.  Patients identified with late neurological complication after irradiation

Case No.	Age (yrs.)	Radiotherapy Lumbal field Ant and post	Biologic dose (Gy)	Latency period (years)	Follow-up	Neurological symptoms	Neurological findings
1	34	3 Gy 12 fractions 6 times a week	52	>10	No progression 24 years after treatment	Minor loss of strength right lower limb.	Missing right patellar- and achilles- reflex, disturbed gait, normal sensibility.
2	35	1.6 Gy twice daily 27 fractions, 1.5 Gy twice daily 1 fraction 5 times a week	59	9 months	Progressive 8.6 years after treatment	Increasing weakness of lower limbs, pain, preventing basic activities. Wheel chair user.	Progressive bilaterally paresis of the lower limbs, missing achilles-and patellar reflex, fasciculations, normal sensibility.
3	31	3.1 Gy 13 fractions, 2.75 Gy 1 fraction 0.95 Gy x 1 fraction 5 times a week	61	17	Progressive 26 years after treatment	Increasing weakness of lower limbs bilaterally, pain, interfering with normal activities. Walk with stick.	Decreased muscle power of lower limbs bilaterally, missing patellar-and achilles reflex, normal sensibility.
4	37	3 Gy 14 fractions 5 times a week	56	13	Progressive 25 years after treatment	Increasing weakness of right lower limb, pain, interfering with normal activities. Peroneal brace.	Drop foot, muscle atrophia, paralysis of ant. muscles on crus, missing patellar-and achilles reflex, normal sensibility.
5	25	3 Gy 15 fractions 5 times a week	60	10	Progressive 29 years after treatment	Increasing weakness of lower limbs bilaterally, preventing basic activities. Wheel chair user.	Progressive bilaterally paresis of the lower limbs, missing achilles-and patellar reflex, fasciculations, normal sensibility.
6	42	3 Gy 17 fractions 5 times a week	62	12	No history after 12 years	Increasing weakness lower limbs, interfering with normal activities.	Missing achilles- and patellar reflex, normal sensibility
7	29	3 Gy x 10 fractions, 2.8 Gy x 4 fractions, 2.3 Gy x 1 fraction, 5 times a week	59	20	Progressive 24 years after treatment	Increasing weakness in left lower limb, interfering with normal activities. Peroneal brace.	Drop foot, muscle atrophia left femur and crus, decreased muscle power, missing achilles reflex, normal sensibility.

Figure 2.  The probability of developing neurological complications after treatment (n = 94)

Figure 3.  Overall survival for all patients divided by histological type.

Figure 4.  The dose-response relationship between calculated biological spinal cord dose and the probability of neurological damage.

Table II.  The number and type of secondary cancer in the radiation field

Secundary cancer	No. of patients	No. died of sec. cancer
Pancreas	7	7
Colon	4	2
Bladder	2	1
Basal cell carcinoma (loin and mons pubis)	2	0
Malignant fibrous histocytoma (loin, L3)	1	0
Peritoneal carcinosis, adenocarcinoma (primary tumor unknown)	1	1
Intraabdominal tumor (no histology)	1	0
Kidney	1	0
Total	19	11

Figure 5.  Illustrates the probability of dying of all causes compared with the probability of dying of complications after radiotherapy. The probability of dying of complications increases constantly during a 30 years period after treatment.