Radiation tolerance of the cervical spinal cord.

Kim, Y H; Fayos, Juan V.

doi:10.1148/radiology.139.2.7220892

Cited by 78 publications

(34 citation statements)

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“…[3][4][5][6] Although 45-50 Gy, when given at 1.8-2 Gy/day, serves as the widely accepted dose limit, contemporary data suggest the spinal cord may be significantly more radiotolerant. A recent review from the University of Florida of 1060 cases showed a 0% incidence of myelitis with doses of 40-45 Gy, a 0.4% incidence for doses between 45 and 50 Gy, and a 0% incidence for doses greater than 50 Gy.…”

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confidence: 99%

Radiation myelitis following allogeneic stem cell transplantation and consolidation radiotherapy for non-Hodgkin's lymphoma

Schwartz

Schechter

Seltzer

et al. 2000

Bone Marrow Transplant

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Summary:Myelitis is a rare but well documented complication of therapeutic radiation exposure to the spinal cord and is characterized by delayed development of paresthesias, sensory changes and, in severe cases, progressive paresis and paralysis. Although accepted radiation tolerance limits for the spinal cord have successfully limited the incidence of this problem (45-50 Gy, in daily 1.8-2 Gy fractions), aggressive systemic therapy may render patients more susceptible to radiation-related neurotoxicity. We describe the case of a 38-year-old man with refractory non-Hodgkin's lymphoma who underwent matched sibling peripheral blood stem cell transplant following a conditioning regimen of cyclophosphamide (60 mg/kg × 2) and total body irradiation (120 cGy × 11). This was followed by delivery of 30.6 Gy involved-field radiation at 1.8 Gy/day to the mediastinum and left supraclavicular fossa for bulky residual tumor. Although maximum cumulative radiation dose to the spinal cord was less than 45 Gy, the patient subsequently developed progressive lower extremity weakness and MRI abnormalities of the spinal cord limited to the radiation field. This represents the second report in the literature of this unexpected complication, prompting a need to reexamine current guidelines for radiotherapy in the context of high-dose systemic treatment. Bone Marrow Transplantation (2000) 26, 1355-1359.

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confidence: 99%

Radiation myelitis following allogeneic stem cell transplantation and consolidation radiotherapy for non-Hodgkin's lymphoma

Schwartz

Schechter

Seltzer

et al. 2000

Bone Marrow Transplant

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“…Seventeen patients developed radiation myelitis, with a mean total dose of 3800 cGy. Kim and Fayos 21 reported seven patients with transverse myelopathy of 109 patients treated with definitive radiotherapy for head and neck cancer; the total dose ranged from 5700 to 6200 cGy, and the mean field size of 10 ϫ 10 cm. Abbatucci, et al, 1 reported eight cases of radiation-induced myelopathy in a series of 203 patients in whom the total radiation dose ranged from 5400 to 6000 cGy targeting the cervical and thoracic spine.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Gerszten

Ozhasoglu

Burton

et al. 2002

FOC

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Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. Methods This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. Conclusions Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

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“…During the early period of the study, the lower supraclavicular regions were not treated routinely. In the later years the lower neck Table 2 Stutirs of tumor at the primary site after irradiation was treated using a single anterior port that covered both sides of the neck with protection of the cervical spinal cord at the junctional area with the lateral ports (22). However, an utmost care was taken in setting these ports so that there was no shielding of the primary tumor even when the separate supraclavicular port was used with its central protective block for the spinal cord.…”

Section: Methodsmentioning

confidence: 99%