Five patients (3 female, 2 male; median age 55 years, range 38-70) developed these complications. 

Brain lesions: Two patients received proton therapy for skull base malignancies -nasopharyngeal (72 Gy/36 fractions) and maxillary sinus carcinoma (70 Gy/33 fractions). RN developed 18-30 months post-RT with cognitive decline, aphasia, and headaches. Imaging demonstrated bitemporal necrosis in one patient and left temporal necrosis in the other. Both received corticosteroids with partial improvement. The first patient received one dose of bevacizumab with limited response and underwent surgery; the other continues bevacizumab with response pending. 

Spinal lesions: Three patients developed thoracic RM (20 Gy/5 fractions via IMRT or 3D-CRT) for osseous metastases from lung cancer, breast cancer, or multiple myeloma. Symptoms developed 10-14 months post-RT, including lower extremity weakness, sensory loss, and autonomic dysfunction. Management included corticosteroids, bevacizumab, hyperbaric oxygen, and physical therapy. Two patients developed deep vein thrombosis after bevacizumab, but both had additional risk factors including concurrent thrombogenic therapy, active malignancy, and limited mobility due to myelopathy. Radiographic improvement was common, with clinical outcomes ranged from partial recovery to persistent deficits.