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01-07-2017 | Original Article

Spinal cord constraints in the era of high-precision radiotherapy

Retrospective analysis of 62 spinal/paraspinal lesions with possible infringements of spinal cord constraints within a minimal volume

Authors: Sebastian Zschaeck, Peter Wust, Reinhold Graf, Waldemar Wlodarczyk, Reinhard Schild, Alexander Henry Thieme, Mirko Weihrauch, Volker Budach, Pirus Ghadjar

Published in: Strahlentherapie und Onkologie | Issue 7/2017

Abstract

Objective

Current constraints aim to minimize the risk of radiation myelitis by the use of restrictive maximal spinal cord doses, commonly 50 Gy. However, several studies suggested that a dose–volume effect could exist. Based on these observations, we evaluated patients receiving potentially excessive doses to the spinal cord within minimal volumes.

Patients and methods

Patients receiving radiotherapy between June 2010 and May 2015 using the Novalis^TM (Varian, Palo Alto, CA, USA; Brainlab, Heimstetten, Germany) radiosurgery system were retrospectively analyzed. A total of 56 patients with 62 treated lesions that had been prescribed radiation doses close to the spinal cord potentially higher than the common 50 Gy 2‑Gy equivalent-dose (EQD2) constraint were selected for further analysis. Of these patients, 26 with 31 lesions had no history of previous irradiation, while 30 patients with 31 lesions had been previously irradiated within the treatment field.

Results

According to different dose evaluation approaches (spinal canal, spinal cord contour), 16 and 10 out of 31 primary irradiated lesions infringed constraints. For the 16 lesions violating spinal canal doses, the maximum doses ranged from 50.5 to 61.9 Gy EQD2. Reirradiated lesions had an average and median cumulative dose of 70.5 and 69 Gy, respectively. Dose drop-off was steep in both groups. Median overall survival was 17 months. No radiation myelitis or radiomorphological alterations were observed during follow-up.

Conclusion

This study adds to the increasing body of evidence indicating that excessive spinal cord doses within a minimal volume, especially in a reirradiation setting with topographically distinct high-point doses, may be given to patients after careful evaluation of treatment- and tumor-associated risks.

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Title: Spinal cord constraints in the era of high-precision radiotherapy
Retrospective analysis of 62 spinal/paraspinal lesions with possible infringements of spinal cord constraints within a minimal volume
Authors: Sebastian Zschaeck
Peter Wust
Reinhold Graf
Waldemar Wlodarczyk
Reinhard Schild
Alexander Henry Thieme
Mirko Weihrauch
Volker Budach
Pirus Ghadjar
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 7/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1138-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Spinal cord constraints in the era of high-precision radiotherapy

Retrospective analysis of 62 spinal/paraspinal lesions with possible infringements of spinal cord constraints within a minimal volume

Abstract

Objective

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Patients and methods

Results

Conclusion

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