[Radiotherapy and spinal toxicity: News and perspectives].

Area of Science:

• Radiation Oncology
• Neurology
• Medical Imaging

Background:

• Radiation-induced myelopathy is a serious, albeit uncommon, late complication following radiotherapy.
• Its clinical presentation is non-specific, often diagnosed between 6-24 months post-treatment, and typically remains a diagnosis of exclusion.
• Spinal cord dose management is critical, particularly in advanced techniques like stereotactic radiotherapy and reirradiation scenarios.

Purpose of the Study:

• To highlight the challenges in diagnosing and managing radiation-induced myelopathy.
• To emphasize the importance of spinal cord dose constraints in radiotherapy planning.
• To discuss the growing need for predictive models in the context of evolving cancer treatment paradigms.

Main Methods:

• Review of clinical presentations and diagnostic approaches for radiation-induced myelopathy.
• Discussion of established spinal cord dose tolerance limits in normofractionated radiotherapy.
• Exploration of risk factors, including concomitant therapies and cumulative doses in reirradiation.
• Mention of magnetic resonance imaging (MRI) as a key diagnostic tool.

Main Results:

• Radiation-induced myelopathy diagnosis is challenging due to its non-specific symptoms and exclusion criteria.
• Standard dose limits (e.g., 50Gy in normofractionated radiotherapy) require careful consideration, especially in reirradiation.
• Concomitant chemotherapy and cumulative radiation doses are significant risk factors.
• Predictive algorithms show promise for risk assessment.

Conclusions:

• Radiation oncologists must exercise extreme caution regarding spinal cord dose, adhering to the ALARA principle.
• The increasing prevalence of stereotactic treatments and reirradiation necessitates improved methods for predicting radiation-induced myelopathy risk.
• Developing predictive algorithms is a major challenge and priority for radiation oncology.