Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients
Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients
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DOI：
10.1016/j.ijrobp.2004.06.016
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发表时间：
2005-03-01
影响因子：
7
通讯作者：
Molls, M
中科院分区：
文献类型：
--
作者：
Nieder, C;Grosu, AL;Molls, M
目的：在大量关于隐性放射损伤恢复的报道的推动下，脊髓再照射被认为是一种现实的选择。在啮齿类动物中，观察到长期恢复开始于约8周。然而，缺乏前瞻性临床研究。因此，所有已发表的临床数据的综合分析可能会提供一个有价值的基础，为未来的trials.Methods和材料：我们收集了数据，从40名患者发表在8个不同的报告后，一个全面的MEDLINE搜索。这些代表了两个疗程中每个疗程的每部分剂量和总剂量数据可用的所有患者。我们根据线性二次模型重新计算生物有效剂量（BED），颈髓和胸髓的α/β值为2戈伊，腰髓为4戈伊。在该模型中，以2戈伊的每日单次剂量给予50戈伊相当于100戈伊（2）或75戈伊（4）的BED。结果：累积剂量范围为108 ~ 205 Gy 2（中位剂量为135戈伊（2））。两个系列之间的中位间隔为20个月。3例患者仅治疗腰椎节段。无脊髓病患者的中位随访时间为17个月。11例患者在4-25个月（中位数，11个月）后发生脊髓病。脊髓病仅见于接受一个疗程剂量大于或等于102 Gy 2的患者（n = 9）或2个月后重新接受治疗的患者（n = 2）。在不存在这两个风险因素的情况下，19例接受136-150戈伊治疗的患者或7例接受136-150 Gy治疗的患者均未发生脊髓病（2）。基于累积BED、特定个体中所有治疗系列中小于或等于5135.5 GY 2的最大BED和间隔制定了风险评分。低风险患者仍无脊髓病，33%的中风险患者和90%的高风险患者发生脊髓病。在这些文献资料的基础上（谨慎起见），脊髓病的风险在小于或等于5135.5戈伊后似乎很小，当间隔时间不短于6个月且每疗程剂量小于或等于98戈伊时（2）在技术上可行的情况下，我们建议将剂量限制在这个水平。然而，建议从接受136-150 GY 2剂量范围内的更多患者中收集前瞻性数据，以评估有限剂量可能影响肿瘤控制的患者的较高再治疗剂量的安全性，这似乎是谨慎的。(C)2005年爱思唯尔公司
Purpose: Driven by numerous reports on recovery of occult radiation injury, reirradiation of the spinal cord today is considered a realistic option. In rodents, long-term recovery was observed to start at approximately 8 weeks. However, prospective clinical studies are lacking. Therefore, a combined analysis of all published clinical data might provide a valuable basis for future trials.Methods and Materials: We collected data from 40 individual patients published in eight different reports after a comprehensive MEDLINE search. These represent all patients with data available for dose per fraction and total dose of each of both treatment courses. We recalculated the biologically effective dose (BED) according to the linear-quadratic model using an alpha/beta value of 2 Gy for the cervical and thoracic cord and 4 Gy for the lumbar cord. In this model, a dose of 50 Gy given in single daily fractions of 2 Gy is equivalent to a BED of 100 GY(2) or 75 GY(4). For treatment with two daily fractions, a correction term was introduced to take incomplete repair of sublethal damage into account.Results: The cumulative doses ranged from 108 to 205 GY2 (median dose, 135 Gy(2). The median interval between both series was 20 months. Three patients were treated to the lumbar segments only. The median follow-up was 17 months for patients without myelopathy. Eleven patients developed myelopathy after 4-25 months (median, 11 months). Myelopathy was seen only in patients who had received one course to a dose of greater than or equal to102 GY2 (n = 9) or were retreated after 2 months (n = 2). In the absence of these two risk factors, no myelopathy developed in 19 patients treated with or 7 patients treated with 136-150 Gy(2). A risk score based on the cumulative BED, the greatest BED for less than or equal to5135.5 GY2 all treatment series in a particular individual, and interval was developed. Low-risk patients remained free of myelopathy and 33% of intermediate-risk patients and 90% of high-risk patients developed myelopathy.Conclusion: On the basis of these literature data (and with due caution), the risk of myelopathy appears small after less than or equal to5135.5 Gy, when the interval is not shorter than 6 months and the dose of each course is less than or equal to98 Gy(2) We would recommend limiting the dose to this level, whenever technically feasible. However, it appears prudent to propose the collection of prospective data from a greater number of patients receiving doses in the range of 136-150 GY2 to assess the safety of higher retreatment doses for those patients in whom limited doses might compromise tumor control. (C) 2005 Elsevier Inc.