Radiation tolerance of the spinal cord

Wara, William M.; Phillips, Theodore L.; Sheline, Glenn E.; Schwade, James G.

doi:10.1002/1097-0142(197506)35:6<1558::aid-cncr2820350613>3.0.co;2-7

Cited by 275 publications

(59 citation statements)

References 11 publications

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“…On the other hand, LG astrocytomas are slow growing tumors and radiotherapy may not be as effective on tumor cells which are currently not undergoing mitosis [26]. Furthermore, radiation tolerance of spinal cord is limited, particularly in the presence of an intrinsic tumor, which makes the tissue more vulnerable to injury [35,44,71]. Long-term survivors treated with mere biopsy and external decompression were reported in some studies [20,27,56].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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“…Medulla spinalis gibi yavaş prolifere olan dokularda geç etkiler çoğun-lukla kalıcı hasarlara neden olur. [2,3,[6][7][8] Yasui ve ark. RM'sini klinik spektruma göre dört kategoriye ayırmışlardır: a) Akut parapleji veya kuadripleji, b) Alt motor nöron bulguları, c) Akut geçici RM, d) Kronik progresif RM.…”

Section: Discussionunclassified

“…Günlük radyasyon dozu, total doz, radyoterapi alanı, lineer enerji transferi, eşzamanlı veya ardışık kemoterapinin uygulanması, kemik iliğini etkileyen kemoterapotiklerin verilmesi, ışın alanına giren medulla spinalisin uzunluğu gibi faktörler miyelopatinin oluşumunu ve şiddetini etkilemektedir. [1][2][3] Nörolojik problem, geçici ve kronik-progresif olmak üzere iki formda görülür. En sık görüleni geçici miyelopatidir.…”

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Radiation myelopathy: a case report

Cihan

2013

TJ Oncol

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Normal tissue injury may lead to severe late side effects after therapeutic use of irradiation. Radiation myelopathy (RM) is an uncommon complication of therapeutic irradiation whenever the spinal cord is included within the radiation treatment field. Several factors such as radiation dose, fractination, linear energy transfer, chemotherapy, modify its occurrence and severity. Herein, we report a 43-year-old male patient with nasopharyngeal cancer who developed RM after concomitant chemoradiotherapy and discussed the literature.

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“…There is also no published experience regarding the tolerance of the human spinal cord to such single-fraction doses. In a review evaluating 172 patients who underwent cervical and thoracic fractionated radiotherapy at the University of California at San Francisco (total dose 4000-7000 cGy fractionated extending 2-3 weeks), Wara, et al, 35 reported nine cases of radiation-induced myelopathy. Three of nine patients experienced mild cervical cord-related neurological deficits without significant long-term symptoms.…”

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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Radiation tolerance of the spinal cord

Cited by 275 publications

References 11 publications

Prognostic factors in intramedullary astrocytomas: a literature review

Prognostic factors in intramedullary astrocytomas: a literature review

Radiation myelopathy: a case report

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

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