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Title: Radiation myelopathy

Abstract

A survey was made of 38 cases of radiation myelopathy with regard to early symptoms and signs, differential diagnosis, prognosis, nature of the primary lesion irradiated, and latency between irradiation and the development of neurological symptoms. Death occurred in 17 of these cases, 1 month to 4 yr after the first neurologic symptoms, as a result of the myelopathy. In most instances the blood vessels and stroma appear to have been predominantly involved. The latent period of several months between irradiation and onset of myelopathic symptoms suggests that the effect is primarily on blood vessels. The findings indicate that new limits should be advised for the permissible dose of radiation to the spinal cord. For treatment times of 42 days the limit for fields greater than 10 cm long should be 3,300 rads, and for flelds less than 10 cm long, 4,300 rads. Idiosyncrasy is obviously a factor in the development of myelopathy, since the survey shows that many patients fail to develop the condition despite having received doses above 3,000 rads in 28 days (for large fields) or 4,300 rads in 42 days (for small fields). It is important to recognize the relative sensitivity of the spinal cord tomore » irradiation, and to plan treatment accordingly. With conventional 240 kv machines (and with some Co/sup 60/ units) the radiation beam has a wide penumba, which sometimes makes it difficult to avoid irradiating the cord (e.g., in post-cricoid cancer, where the irradiated volume must include the anterior surface of the cervical vertebrae). Supervoltage machines however, such as the linear accelerator, produce a very much better collimated beam with little penumbra, and with such machines it is usually much easier to avoid irradiating the cord. With supervoltage radiation the energy absorbed in bone is very nearly equal to that absorbed in soft tissue, and the dose delivered to the spinal cord can therefore be estimated more accurately than with lower energy radiation. Thus, supervoltage radiation is probably the method of choice in the treatment of tumors adjacent to the spinal cord.« less

Authors:
; ;
Publication Date:
Research Org.:
Postgraduate Medical School, London
Sponsoring Org.:
USDOE
OSTI Identifier:
4780822
NSA Number:
NSA-16-032768
Resource Type:
Journal Article
Journal Name:
Brain (Journal of Neurology)
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Orig. Receipt Date: 31-DEC-62; Journal ID: ISSN 0006-8950
Country of Publication:
Country unknown/Code not available
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABSORPTION; BLOOD VESSELS; BONES; CANCER; COBALT 60; DIAGNOSIS; EFFICIENCY; ENERGY RANGE; MEDICINE; NERVOUS SYSTEM; QUANTITATIVE ANALYSIS; RADIATION DOSES; RADIATION INJURIES; RADIATION SOURCES; RADIOSENSITIVITY; RADIOTHERAPY; SPINAL CORD; TISSUES; TUMORS

Citation Formats

PALLIS, CHRISTOPHER A., LOUIS, SYDNEY, and MORGAN, ROWLAND L. Radiation myelopathy. Country unknown/Code not available: N. p., 1961. Web. doi:10.1093/brain/84.3.460.
PALLIS, CHRISTOPHER A., LOUIS, SYDNEY, & MORGAN, ROWLAND L. Radiation myelopathy. Country unknown/Code not available. doi:10.1093/brain/84.3.460.
PALLIS, CHRISTOPHER A., LOUIS, SYDNEY, and MORGAN, ROWLAND L. Sun . "Radiation myelopathy". Country unknown/Code not available. doi:10.1093/brain/84.3.460.
@article{osti_4780822,
title = {Radiation myelopathy},
author = {PALLIS, CHRISTOPHER A. and LOUIS, SYDNEY and MORGAN, ROWLAND L.},
abstractNote = {A survey was made of 38 cases of radiation myelopathy with regard to early symptoms and signs, differential diagnosis, prognosis, nature of the primary lesion irradiated, and latency between irradiation and the development of neurological symptoms. Death occurred in 17 of these cases, 1 month to 4 yr after the first neurologic symptoms, as a result of the myelopathy. In most instances the blood vessels and stroma appear to have been predominantly involved. The latent period of several months between irradiation and onset of myelopathic symptoms suggests that the effect is primarily on blood vessels. The findings indicate that new limits should be advised for the permissible dose of radiation to the spinal cord. For treatment times of 42 days the limit for fields greater than 10 cm long should be 3,300 rads, and for flelds less than 10 cm long, 4,300 rads. Idiosyncrasy is obviously a factor in the development of myelopathy, since the survey shows that many patients fail to develop the condition despite having received doses above 3,000 rads in 28 days (for large fields) or 4,300 rads in 42 days (for small fields). It is important to recognize the relative sensitivity of the spinal cord to irradiation, and to plan treatment accordingly. With conventional 240 kv machines (and with some Co/sup 60/ units) the radiation beam has a wide penumba, which sometimes makes it difficult to avoid irradiating the cord (e.g., in post-cricoid cancer, where the irradiated volume must include the anterior surface of the cervical vertebrae). Supervoltage machines however, such as the linear accelerator, produce a very much better collimated beam with little penumbra, and with such machines it is usually much easier to avoid irradiating the cord. With supervoltage radiation the energy absorbed in bone is very nearly equal to that absorbed in soft tissue, and the dose delivered to the spinal cord can therefore be estimated more accurately than with lower energy radiation. Thus, supervoltage radiation is probably the method of choice in the treatment of tumors adjacent to the spinal cord.},
doi = {10.1093/brain/84.3.460},
journal = {Brain (Journal of Neurology)},
issn = {0006-8950},
number = 3,
volume = 84,
place = {Country unknown/Code not available},
year = {1961},
month = {1}
}