Cardiac Toxicity After Craniospinal Irradiation: A Late Effect That May be Eliminated With Proton Therapy

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Background:Craniospinal irradiation (CSI) is commonly required for pediatric patients with central nervous system malignancies. Traditionally, CSI is given using x-rays to deliver radiation to the brain and spine, exposing normal anterior structures, including heart, to unnecessary radiation.Observations:We present a patient treated with x-ray CSI for medulloblastoma with spinal metastasis (3600 cGy CSI with focal boost to 5000 cGy), who subsequently developed significant cardiac toxicity, likely related to radiation exposure.Conclusions:Spinal irradiation can cause significant cardiac risk due to exit dose through anterior structures. This toxicity may be avoided with proton therapy, which eliminates visceral exit dose.

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