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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.<\/jats:p>","DOI":"10.1136\/pn-2022-003343","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T13:22:55Z","timestamp":1661174575000},"page":"450-460","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Radiation and the nervous system"],"prefix":"10.1136","volume":"22","author":[{"given":"Michael","family":"Kosmin","sequence":"first","affiliation":[{"name":"Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"NIHR University College London Hospitals Biomedical Research Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-9551","authenticated-orcid":false,"given":"Jeremy","family":"Rees","sequence":"additional","affiliation":[{"name":"Neurology, National Hospital for Neurology and Neurosurgery, London, UK"},{"name":"National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,22]]},"reference":[{"key":"2025090409334192000_22.6.450.1","doi-asserted-by":"crossref","unstructured":"Joiner M , van der Kogel A . 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