ABSTRACT
This chapter summarizes the serious late complications associated with intracranial and spinal image-guided hypofractionated radiotherapy (IG-HSRT) and the strategies to mitigate the risks. It covers the most important complications including optic neuropathy and other cranial nerve injuries, vascular injury, brainstem injury, and radiation necrosis. The chapter also covers radiation myelopathy, vertebral compression fracture, radiation plexopathy, neuropathy, pain flare, and esophageal injury. Rare occurrence of radiation myelopathy has been observed after spinal SBRT in both radiation-naïve and reirradiated patients. Radiotherapy, frequently used as a treatment for bone metastasis, can increase the risk of vertebral compression fracture, but the risk is deemed to be low in general with conventional palliative radiotherapy. Radiation radiculopathy or plexopathy is uncommonly encountered after SBRT for spinal tumors. The use of a multiple session regimen may decrease the risk of serious esophageal toxicities from SBRT if the dose constraint cannot be met in one fraction.
