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Re-irradiation of the human spinal cord

Abstract

Purpose: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimes were designed for eight patients who required palliative radiotherapy. As a consequence of reirradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented. Patients and method: Eight patients were re-irradiated on the cervical (n=1), thoracic (n=5) and lumbar (n=2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity ({alpha}/{beta} ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BED{sub tolerance} of 100 Gy and 84 Gy, respectively. Results: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BED{sub tolerance}. During follow-up, ranging from 33 days to >4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive. Conclusion: Long-term recovery of the spinal cord from radiation  More>>
Authors:
Sminia, P; [1]  Academic Medical Center, Amsterdam (Netherlands)]; Oldenburger, F; Hulshof, M C.C.M.; [2]  Slotman, B J; [1]  Schneider, J J; [2]  Netherlands Cancer Inst./Antoni van Leeuwenhoek Hospital, Amsterdam (Germany)]
  1. VU University Medical Center, Amsterdam (Netherlands)
  2. Academic Medical Center, Amsterdam (Netherlands)
Publication Date:
Aug 01, 2002
Product Type:
Journal Article
Resource Relation:
Journal Name: Strahlentherapie und Onkologie; Journal Volume: 178; Journal Issue: 8; Other Information: PBD: Aug 2002
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; 61 RADIATION PROTECTION AND DOSIMETRY; PATIENTS; BONE MARROW; RADIOTHERAPY; RADIATION DOSES; BIOLOGICAL REPAIR; CHEST; NECK; PELVIS; SIDE EFFECTS; NEOPLASMS; EFFICIENCY
OSTI ID:
20330846
Country of Origin:
Germany
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0179-7158; STONE4; TRN: DE03F2556
Submitting Site:
DEN
Size:
page(s) 453-456
Announcement Date:

Citation Formats

Sminia, P, Academic Medical Center, Amsterdam (Netherlands)], Oldenburger, F, Hulshof, M C.C.M., Slotman, B J, Schneider, J J, and Netherlands Cancer Inst./Antoni van Leeuwenhoek Hospital, Amsterdam (Germany)]. Re-irradiation of the human spinal cord. Germany: N. p., 2002. Web. doi:10.1007/s00066-002-0948-1.
Sminia, P, Academic Medical Center, Amsterdam (Netherlands)], Oldenburger, F, Hulshof, M C.C.M., Slotman, B J, Schneider, J J, & Netherlands Cancer Inst./Antoni van Leeuwenhoek Hospital, Amsterdam (Germany)]. Re-irradiation of the human spinal cord. Germany. doi:10.1007/s00066-002-0948-1.
Sminia, P, Academic Medical Center, Amsterdam (Netherlands)], Oldenburger, F, Hulshof, M C.C.M., Slotman, B J, Schneider, J J, and Netherlands Cancer Inst./Antoni van Leeuwenhoek Hospital, Amsterdam (Germany)]. 2002. "Re-irradiation of the human spinal cord." Germany. doi:10.1007/s00066-002-0948-1. https://www.osti.gov/servlets/purl/10.1007/s00066-002-0948-1.
@misc{etde_20330846,
title = {Re-irradiation of the human spinal cord}
author = {Sminia, P, Academic Medical Center, Amsterdam (Netherlands)], Oldenburger, F, Hulshof, M C.C.M., Slotman, B J, Schneider, J J, and Netherlands Cancer Inst./Antoni van Leeuwenhoek Hospital, Amsterdam (Germany)]}
abstractNote = {Purpose: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimes were designed for eight patients who required palliative radiotherapy. As a consequence of reirradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented. Patients and method: Eight patients were re-irradiated on the cervical (n=1), thoracic (n=5) and lumbar (n=2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity ({alpha}/{beta} ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BED{sub tolerance} of 100 Gy and 84 Gy, respectively. Results: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BED{sub tolerance}. During follow-up, ranging from 33 days to >4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive. Conclusion: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans. (orig.) [German] Gegenstand: Tierversuchsdaten belegen eine Langzeiterholung des Rueckenmarks nach Bestrahlung. Nach Extrapolation dieser Daten wurden Wiederbestrahlungsregimes fuer acht Patienten, die eine palliative Radiotherapie benoetigten, entworfen. Als Konsequenz wurde das Rueckenmark dieser Patienten einer kumulativen Dosis ausgesetzt, die die Rueckenmarkstoleranzdosis ueberschritt. Radiobiologische und klinische Daten werden praesentiert. Patienten und Methodik: Bei acht Patienten wurden das zervikale (n=1), thorakale (n=5) und das lumbale (n=2) Rueckenmark erneut bestrahlt. Das Zeitintervall zwischen Erst- und Wiederbehandlung lag bei 4 Monaten bis 12,7 Jahren (Median = 2,5 Jahre). (Wieder-)Behandlungsschemata wurden auf der Basis der bilogischen effektiven Dosis (BED) anhand des linearquadratischen Modells entworfen und analysiert. Als Reparaturkapazitaet ({alpha}/{beta}-Wert) wurden fuer das zervikothorakale Rueckenmark 2 Gy und fuer das lumbale Rueckenmark 4 Gy mit einer BED von 100 Gy bzw. 84 Gy angenommen. Ergebnisse: Die kumulative Bestrahlungsdosis im Rueckenmark variierte zwischen 125% und 172% der BED{sub Toleranz}. Waehrend der Nachbeobachtungsperiode (zwischen 33 Tagen und bis zu 4,5 Jahren, Median=370 Tage) entwickelte kein Patient neurologische Komplikationen. Sieben Patienten starben infolge einer Tumorprogression, ein Patient ist noch am Leben. Schlussfolgerung: Langzeiterholungsphaenomene des Rueckenmarks nach Bestrahlung - bei Nagetieren und Primaten belegt - sind auch beim Menschen als wahrscheinlich anzunehmen. (orig.)}
doi = {10.1007/s00066-002-0948-1}
journal = {Strahlentherapie und Onkologie}
issue = {8}
volume = {178}
journal type = {AC}
place = {Germany}
year = {2002}
month = {Aug}
}