Hyperbaric oxygen therapy for chemoradiation myelitis

Radiation induced myelitis is a rare complication following high dose radiotherapy. Intrathecal chemotherapy accelerates its CNS effects. We report a young woman with aggressive lymphoma presented as superior vena cava syndrome. The patient was treated with radiotherapy and intrathecal chemotherapy, achieved complete remission and 17 month later developed chronic progressive radiation myelitis (CPRM). The difficulties of diagnosis and management of CPRM are discussed. In the absence of clear guidelines, and since there is no clear effective treatment, we decided to treat the patient with hyper baric oxygen with slight improvement and stabilization in her neurological condition. Clearly, more experience and well controlled trials to establish guidelines are needed.