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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 6/2021

Open Access 01-06-2021 | Radiotherapy | Original Article

New clinical data on human spinal cord re-irradiation tolerance

Authors: Hiroshi Doi, MD, PhD, Keisuke Tamari, MD, PhD, Ryoong-Jin Oh, MD, Carsten Nieder, MD

Published in: Strahlentherapie und Onkologie | Issue 6/2021

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Abstract

Purpose

To provide additional clinical data about the re-irradiation tolerance of the spinal cord.

Methods

This was a retrospective bi-institutional study of patients re-irradiated to the cervical or thoracic spinal cord with minimum follow-up of 6 months. The maximum dose (Dmax) and dose to 0.1cc (D0.1cc) were determined (magnetic resonance imaging [MRI]-defined cord) and expressed as equivalent dose in 2‑Gy fractions (EQD2) with an α/β value of 2 Gy.

Results

All 32 patients remained free from radiation myelopathy after a median follow-up of 12 months. Re-irradiation was performed after 6–97 months (median 15). In 22 cases (69%) the re-irradiation spinal cord EQD2 Dmax was higher than that of the first treatment course. Forty-eight of 64 treatment courses employed fraction sizes of 2.5 to 4 Gy to the target volume. The median cumulative spinal cord EQD2 Dmax was 80.7 Gy, minimum 61.12 Gy, maximum 114.79 Gy. The median cumulative spinal cord D0.1cc EQD2 was 76.1 Gy, minimum 61.12 Gy, maximum 95.62 Gy. Besides cumulative dose, other risk factors for myelopathy were present (single-course Dmax EQD2 ≥51 Gy in 9 patients, single-course D0.1cc EQD2 ≥51 Gy in 5 patients).

Conclusion

Even patients treated to higher cumulative doses than previously recommended, or at a considerable risk of myelopathy according to a published risk score, remained free from this complication, although one must acknowledge the potential for manifestation of damage in patients currently alive, i.e., still at risk. Individualized decisions to re-irradiate after appropriate informed consent are an acceptable strategy, including scenarios where low re-irradiation doses to the spinal cord would compromise target coverage and tumor control probability to an unacceptable degree.
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Metadata
Title
New clinical data on human spinal cord re-irradiation tolerance
Authors
Hiroshi Doi, MD, PhD
Keisuke Tamari, MD, PhD
Ryoong-Jin Oh, MD
Carsten Nieder, MD
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Keyword
Radiotherapy
Published in
Strahlentherapie und Onkologie / Issue 6/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-021-01772-7

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