International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 3, Supplement , Pages S42-S49 , 1 March 2010

Radiation Dose–Volume Effects in the Spinal Cord

  • John P. Kirkpatrick, M.D., Ph.D.

      Affiliations

    • Department of Radiation Oncology, Duke University Medical Center, Durham, NC
    • Corresponding Author InformationReprint requests to: John P. Kirkpatrick, M.D., Ph.D., Department of Radiation Oncology, Duke University Medical Center, Box 3085, Durham, NC 27710. Tel: (919) 668-7342; Fax: (919) 668-7345
  • ,
  • Albert J. van der Kogel, Ph.D.

      Affiliations

    • Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  • ,
  • Timothy E. Schultheiss, Ph.D.

      Affiliations

    • Department of Radiation Physics, City of Hope Cancer Center, Duarte, CA

Received 10 March 2009 ,Revised 17 April 2009 ,Accepted 22 April 2009.

References 

  1. Goetz C. Textbook of clinical neurology. 2nd ed.. Chicago, IL: Saunders; 2003;
  2. Klimo P, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005;7:64–76
  3. Schultheiss TE, Kun LE, Ang KK, et al. Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 1995;31:1093–1112
  4. Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS, March 31, 2003. Available online at: http://ctep.cancer.gov. Accessed August 31, 2008.
  5. Abbatucci JS, DeLozier T, Quint R, et al. Radiation myelopathy of the cervical spinal cord. Time, dose, and volume factors. Int J Radiat Oncol Biol Phys. 1978;4:239–248
  6. Saghal A, Larson D, Chang EL. Stereotactic body radiosurgery for spinal metastases: A critical review. Int J Radiat Oncol Biol Phys. 2008;71:652–665
  7. Ryu S, Jin JY, Jin R, et al. Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery. Cancer. 2007;109:628–636
  8. Philippens ME, Pop LA, Visser AG, et al. Dose-volume effects in rat thoracolumbar spinal cord: The effects of nonuniform dose distribution. Int J Radiat Oncol Biol Phys. 2007;69:204–213
  9. Coderre JA, Morris GM, Micca PL, et al. Late effects of radiation on the central nervous system: Role of vascular endothelial damage and glial stem cell survival. Radiat Res. 2006;166:495–503
  10. Bijl HP, van Luijk P, Coppes RP, et al. Dose-volume effects in the rat cervical spinal cord after proton irradiation. Int J Radiat Oncol Biol Phys. 2002;52:205–211
  11. Bijl HP, van Luijk P, Coppes RP, et al. Regional differences in radiosensitivity across the rat cervical spinal cord. Int J Radiat Oncol Biol Phys. 2005;61:543–551
  12. Ang KK, van der Kogel AJ, van der Schueren E, et al. The effect of small radiation doses on the rat spinal cord: The concept of partial tolerance. Int J Radiat Oncol Biol Phys. 1983;9:1487–1491
  13. Ang KK, Price RE, Stephens LC, et al. The tolerance of primate spinal cord to re-irradiation. Int J Radiat Oncol Biol Phys. 1993;25:459–464
  14. Ang KK, Jiang GL, Feng Y, et al. Extent and kinetics of recovery of occult spinal cord injury. Int J Radiat Oncol Biol Phys. 2001;50:1013–1020
  15. Knowles JF. The radiosensitivity of the guinea-pig spinal cord to X-rays: The effect of retreatment at one year and the effect of age at the time of irradiation. Int J Radiat Biol Relat Stud Phys Chem Med. 1983;44:433–442
  16. Ruifrok AC, Kleiboer BJ, van der Kogel AJ. Repair kinetics of radiation damage in the developing rat cervical spinal cord. Int J Radiat Biol. 1993;63:501–508
  17. Wong CS, Hao Y. Long-term recovery kinetics of radiation damage in rat spinal cord. Int J Radiat Oncol Biol Phys. 1997;37:171–179
  18. Schultheiss TE. The radiation dose-response of the human spinal cord. Int J Radiat Oncol Biol Phys. 2008;71:1455–1459
  19. McCunniff AJ, Lliang MJ. Radiation tolerance of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 1989;16:675–678
  20. Atkins HL, Tretter P. Time-dose considerations in radiation myelopathy. Acta Radiol Ther Phys Biol Gy. 1966;5:79–94
  21. Marcus RB, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 1990;93:3–8
  22. Jeremic BJ, Djuric L, Mijatovic L. Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater. Cancer. 1991;68:2138–2141
  23. Hazra TA, Chandrasekaran MS, Colman M, et al. Survival in carcinoma of the lung after a split course of radiotherapy. Br J Radiol. 1974;47:464–466
  24. Choi NCH, Grillo HC, Gardiello M, et al. Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma. Int J Radiat Oncol Biol Phys. 1980;6:31–35
  25. Abramson N, Cavanaugh PJ. Short-course radiation therapy in carcinoma of the lung. Radiology. 1973;108:685–687
  26. Fitzgerald RH, Marks RD, Wallace KM. Chronic radiation myelitis. Radiology. 1982;144:609–612
  27. Madden FJF, English JSC, Moore AK, et al. Split course radiation in inoperable carcinoma of the bronchus. Eur J Cancer. 1979;15:1175–1177
  28. Guthrie RT, Ptacek JJ, Hjass AC. Comparative analysis of two regimens of split course radiation in carcinoma of the lung. Am J Roentgenol. 1973;117:605–608
  29. Dische S, Warburton MF, Sanders MI. Radiation myelitis and survival in the radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys. 1988;15:75–81
  30. Hatlevoll R, Host H, Kaalhus O. Myelopathy following radiotherapy of bronchial carcinoma with large single fractions: A retrospective study. Int J Radiat Oncol Biol Phys. 1983;9:41–44
  31. Eichhorn HJ, Lessel A, Rotte KH. Einfuss verschiedener Bestrahlungsrhythmen auf Tumor-und Normalgewebe in vivo. Strahlentheraphie. 1972;146:614–629
  32. Scruggs H, El-Mahdi A, Marks RD, et al. The results of split-course radiation therapy in cancer of the lung. Am J Roentgenol Radium Ther Nucl Med. 1974;121:754–760
  33. Macbeth FR, Bolger JJ, Hopwood P, et al. Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. [see comment] Clin Oncol (R Coll Radiol). 1996;8:167–175
  34. Macbeth FR, Wheldon TE, Girling DJ, et al. Radiation myelopathy: Estimates of risk in 1048 patients in three randomized trials of palliative radiotherapy for non-small cell lung cancer. The Medical Research Council Lung Cancer Working Party. Clin Oncol (R Coll Radiol). 1996;8:176–181
  35. Nieder C, Grosu AL, Andratschke NH, et al. Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients. Int J Radiat Oncol Biol Phys. 2005;61:851–855
  36. Wright JL, Lovelock DM, Bilsky MH, et al. Clinical outcomes after reirradiation of paraspinal tumors. Am J Clin Oncol. 2006;29:495–502
  37. Langendijk JA, Kasperts N, Leemans CR, et al. A phase II study of primary reirradiation in squamous cell carcinoma of head and neck. Radiother Oncol. 2006;78:306–312
  38. Grosu AL, Andratschke N, Nieder C, et al. Retreatment of the spinal cord with palliative radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52:1288–1292
  39. Nieder C, Grosu AL, Andratschke NH, et al. Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys. 2006;66:1446–1449
  40. Schiff D, Shaw EG, Cascino TL. Outcome after spinal reirradiation for malignant epidural spinal cord compression. Ann Neurol. 1995;37:583–5899
  41. Ryu S, Gorty S, Kazee AM, et al. Reirradiation of human cervical spinal cord. Am J Clin Oncol. 2000;23:29–31
  42. Kuo JV, Cabebe E, Al-Ghazi M, et al. Intensity-modulated radiation therapy for the spine at the University of California, Irvine. Med Dosim. 2002;27:137–145
  43. Bauman GS, Sneed PK, Wara WM, et al. Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys. 1996;36:433–441
  44. Sminia P, Oldenburger F, Slotman BJ, et al. Re-irradiation of the human spinal cord. Strahlenther Onkol. 2002;178:453–456
  45. Magrini SM, Biti GP, de Scisciolo G, et al. Neurological damage in patients irradiated twice on the spinal cord: A morphologic and electrophysiological study. Radiother Oncol. 1990;17:209–218
  46. Rades D, Stalpers LJA, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol. 2005;23:3366–3375
  47. Jackson MA, Ball DL. Palliative retreatment of locally recurrent lung cancer after radical radiotherapy. Med J Aust. 1987;147:391–394
  48. Wong CS, Van Dyk J, Milosevic M, et al. Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys. 1994;30:575–581
  49. Gwak H-S, Yoo H-J, Youn S-M, et al. Hypofractionated stereotactic radiotherapy for skull base and upper cervical chordoma and chondrosarcoma: Preliminary results. Stereotact Funct Neurosurg. 2005;83:233–243
  50. Gibbs IC, Patil I, Gerszten PC, et al. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurg. 2009;64(2 Suppl):A67–A72
  51. Benzil DL, Saboori M, Mogilner AY, et al. Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg. 2004;101(Suppl 3):413–418
  52. Sahgal A, Choua D, Amesa C, et al. Proximity of spinous/paraspinous radiosurgery metastatic targets to the spinal cord versus risk of local failure. Int J Radiat Oncol Biol Phys. 2007;69:S243
  53. Sahgal A, Chou D, Ames C, et al. Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: The University of California San Francisco preliminary experience. Technol Cancer Res Treat. 2007;6:595–604
  54. Chang EL, Shiu AS, Mendel E, et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine. 2007;7:151–160
  55. Gerszten PC, Burton SA, Welch WC, et al. Single-fraction radiosurgery for the treatment of spinal breast metastases. Cancer. 2005;104:2244–2254
  56. Nelson JW, Yoo DS, Wang Z, et al. Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys. 2009;73:1369–1375
  57. Ruifrok AC, Kleiboer BJ, van der Kogel AJ. Radiation tolerance of the immature rat spinal cord. Radiother Oncol. 1992;23:249–256
  58. Ruifrok AC, Kleiboer BJ, van der Kogel AJ. Radiation tolerance and fractionation sensitivity of the developing rat cervical spinal cord. Int J Radiat Oncol Biol Phys. 1992;24:505–510
  59. Ruifrok AC, Stephens LC, van der Kogel AJ. Radiation response of the rat cervical spinal cord after irradiation at different ages: Tolerance, latency and pathology. Int J Radiat Oncol Biol Phys. 1994;29:73–79
  60. Friedman DL, Constine LS. Late effects of cancer treatment. In:  Halperin EC,  Constine LS,  Tarbell NJ,  Kun LE editor. Pediatric radiation oncology. Philadelphia: Lippincott, Williams & Wilkins; 2005;
  61. Ruifrok AC, van der Kogel AJ. The effect of intraspinal cytosine arabinoside on the re-irradiation tolerance of the cervical spinal cord of young and adult rats. Eur J Cancer. 1993;29A:1766–1770
  62. Grégoire V, Ruifrok AC, Price RE, et al. Effect of intra-peritoneal fludarabine on rat spinal cord tolerance to fractionated irradiation. Radiother Oncol. 1995;36:50–55
  63. Ruckdeschel JC, Baxter DH, McKneally MF, et al. Sequential radiotherapy and Adriamycin in the management of bronchogenic carcinoma: The question of additive toxicity. Int J Radiat Oncol Biol Phys. 1979;5:1323–1328
  64. Bloss JD, DiSaia PJ, Mannel RS, et al. Radiation myelitis: A complication of concurrent cisplatin and 5-fluorouracil chemotherapy with extended field radiotherapy for carcinoma of the uterine cervix. Gynecol Oncol. 1991;43:305–308
  65. Chao MW, Wirth A, Ryan G, et al. Radiation myelopathy following transplantation and radiotherapy for non-Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys. 1998;41:1057–1061
  66. Seddon BM, Cassoni AM, Galloway MJ, et al. Fatal radiation myelopathy after high-dose busulfan and melphalan chemotherapy and radiotherapy for Ewing's sarcoma: A review of the literature and implications for practice. Clin Oncol (R Coll Radiol). 2005;17:385–390
  67. Lee YY, Nauert C, Glass JP. Treatment-related white matter changes in cancer patients. Cancer. 1986;57:1473–1482
  68. Schultheiss TE, Kun LE, Ang KK, et al. Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 1995;31:1093–1112
  69. Schultheiss TE, Thames HD, Peters LJ, et al. Effect of latency on calculated complication rates. Int J Radiat Oncol Biol Phys. 1986;12:1861–1865
  70. Kirkpatrick JP, Meyer JJ, Marks LB. The linear-quadratic model is inappropriate to model high-dose per fraction effects. Semin Radiat Oncol. 2008;18:240–243

PII: S0360-3016(09)03296-9

doi: 10.1016/j.ijrobp.2009.04.095

International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 3, Supplement , Pages S42-S49 , 1 March 2010