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Radiation and the nervous system
  1. Michael Kosmin1,2,
  2. Jeremy Rees3,4
  1. 1Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2NIHR University College London Hospitals Biomedical Research Centre, London, UK
  3. 3Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  4. 4National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Jeremy Rees, Neurology, National Hospital for Neurology and Neurosurgery, London, UK; jeremy.rees{at}


Radiation therapy is widely used for benign and malignant brain tumours as it is effective and well tolerated. However, damage to the surrounding healthy nervous system tissue leads to a variety of complications both in the short term and long term, ranging from mild and self-limiting to irreversible and fatal. Radiation neurotoxicity is due to a combination of early inflammation and oligodendroglial damage followed later by brain tissue necrosis, white matter damage, accelerated vascular disease and the development of secondary tumours. This article explains the basic principles of radiation physics, the different modalities used in clinical practice, how radiotherapy is planned and delivered and the scientific basis of radiation damage. The main body of the article focuses on the clinical features of radiation toxicity in the brain, spinal cord, cranial and peripheral nerves with an emphasis on the distinction between early and delayed complications.

  • radiotherapy
  • cerebrovascular disease
  • clinical neurology
  • cognition
  • dementia

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  • Contributors MK contributed the section on Mechanisms of radiation damage, treatment planning and dose fractionation; JR designed the concept of the paper, wrote the section on radiation complications, key points, figures and legends and subsequent revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Provenance and peer review. Commissioned. Externally peer reviewed by Robin Grant, Edinburgh, UK and Fiona McKevitt, Sheffield, UK.

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