A 54-year-old man with previously treated (chemoradiation and surgery without concurrent corticosteroids) squamous cell carcinoma of the right tonsil developed a paraparesis and thoracic truncal sensory disturbance at T3 after completing 15 months of cisplatin-based chemoradiotherapy (estimated spinal cord dose, 4800 cGy [to convert centigray to rad, multiply by 100]). The clinical and radiographic findings (Figure, A and B) were consistent with delayed late radiation myelitis. Treatment was initiated with 4 cycles of bevacizumab (5 mg/kg once every 2 weeks), resulting in clinical stabilization and apparent regression by radiography (Figure, C and D). Following treatment with bevacizumab only, the patient was able to resume playing golf and ambulated without an assistive device.
Figure. Postradiation myelitis before and after bevacizumab therapy. Sagittal postgadolinium T1 with fat suppression (A) and T2 images (B) show intramedullary nodular enhancement at the C7-T1 level (A, arrow) with cord edema extending from C5 to T4 (B, arrowheads). Follow-up images after bevacizumab therapy (C and D) show complete resolution of these findings.
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