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All radioactive nuclides emit high-energy particles or electromagnetic waves. When this radiation encounters living cells, it can cause heating, break chemical bonds, or ionize molecules. The most serious biological damage results when these radioactive emissions fragment or ionize molecules. For example, α and β particles emitted from nuclear decay reactions possess much higher energies than ordinary chemical bond energies. When these particles strike and penetrate matter, they produce ions...
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Radiation dose-volume effects in the spinal cord.

John P Kirkpatrick1, Albert J van der Kogel, Timothy E Schultheiss

  • 1Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA. jkirk@radonc.duke.edu

International Journal of Radiation Oncology, Biology, Physics
|February 23, 2010
PubMed
Summary

Radiotherapy dose limits for spinal cord myelopathy are reviewed. Lower doses reduce risk, but long-term data for hypofractionated regimens are insufficient.

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Area of Science:

  • Radiation Oncology
  • Neurology

Background:

  • Spinal cord myelopathy is a serious complication of radiotherapy.
  • Understanding dose-volume constraints is crucial for safe treatment planning.

Purpose of the Study:

  • To review dose-volume data for human spinal cord myelopathy after radiotherapy.
  • To assess risks associated with conventional and stereotactic radiotherapy regimens.

Main Methods:

  • Review of existing dose-volume data for myelopathy in humans and preclinical studies.
  • Analysis of reirradiation data in animals and humans.
  • Evaluation of stereotactic radiosurgery data for spinal lesions.

Main Results:

  • With conventional fractionation (1.8-2 Gy/fraction), myelopathy risk is <1% at 54 Gy and <10% at 61 Gy.
  • A strong dose/fraction dependence (alpha/beta = 0.87 Gy) was calculated.
  • Reirradiation suggests subclinical damage repair occurs over 6 months to 2 years.
  • Stereotactic radiosurgery shows rare myelopathy (<1%) when doses are limited (e.g., 13 Gy single fraction).

Conclusions:

  • Established dose constraints for conventional radiotherapy help minimize myelopathy risk.
  • Partial repair of radiation-induced damage is observed.
  • Insufficient long-term data exists for hypofractionated partial cord treatments.