Spinal cord tolerance to reirradiation with single-fraction radiosurgery: a swine model.
Spinal cord tolerance to reirradiation with single-fraction radiosurgery: a swine model.
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DOI：
10.1016/j.ijrobp.2011.08.030
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发表时间：
2012-07-01
影响因子：
7
通讯作者：
Solberg, Timothy D.
中科院分区：
文献类型：
--
作者：
Medin, Paul M.;Foster, Ryan D.;van der Kogel, Albert J.;Sayre, James W.;McBride, William H.;Solberg, Timothy D.
本实验研究了猪脊髓对30 Gy分10次均匀照射后1年的单次部分体积照射耐受性。对10 cm长的脊髓（C3-T1）进行连续10次30 Gy的均匀照射，1年后在先前照射节段的中心进行单次放射外科剂量的再照射。将放射外科手术输送到位于颈脊髓外侧的约5cm长、2cm直径的圆柱体中，导致剂量分布，90%、50%和10%等剂量线分别穿过同侧、中央和对侧脊髓。将23头猪分为6个剂量组，平均最大脊髓剂量分别为14.9±0.1（n=2）、17.1±0.3（n=3）、19.0±0.1（n =5）、21.2±0.1（n =5）、23.4±0.2（n=5）和25.4±0.4（n=3）戈伊。相同组接受≥ 10 Gy的脊髓体积平均百分比分别为34%±1、40%±1、46%±3、52%±1、56±3和57%±1。研究终点是通过一年随访期间步态变化确定的运动神经功能缺损。最大点剂量为19.7Gy（17.4-21.4）时，ED 50（95%CI）为陡峭的剂量-反应曲线。除了两个例外，在神经系统状态正常的动物中，组织学无异常，而所有运动缺陷的动物在辐照侧显示一定程度的脱髓鞘和局灶性白色坏死，灰质相对较少。组织学比较与从头照射动物的同伴研究显示，再治疗反应者具有更广泛的组织损伤，包括灰质梗死，仅在处方剂量> 20 Gy时。在10次30 Gy照射后一年接受脊柱放射外科治疗的猪发生运动缺陷的风险并不显著高于仅接受放射外科治疗的猪。
This study was performed to determine the spinal cord tolerance of swine to single-fraction, partial-volume irradiation one year after uniform irradiation to 30Gy in 10 fractions. A 10cm length of spinal cord (C3-T1) was uniformly irradiated to 30Gy in ten consecutive fractions and reirradiated one year later with a single radiosurgery dose centered within the previously irradiated segment. Radiosurgery was delivered to a cylindrical volume approximately 5cm in length and 2cm in diameter that was positioned lateral to the cervical spinal cord resulting in a dose distribution with the 90%, 50% and 10% isodose lines traversing the ipsilateral, central and contralateral spinal cord, respectively. Twenty-three pigs were stratified into six dose groups with mean maximum spinal cord doses of 14.9±0.1 (n=2), 17.1±0.3 (n=3), 19.0±0.1 (n=5), 21.2±0.1 (n=5), 23.4±0.2 (n=5), and 25.4±0.4 (n=3)Gy. The mean percentage spinal cord volumes receiving >=10Gy for the same groups were 34%±1, 40%±1, 46%±3, 52%±1, 56±3, and 57%±1. The study endpoint was motor neurologic deficit determined by a change in gait during a one year follow-up period. A steep dose-response curve was observed with an ED50(95% CI) for the maximum point dose of 19.7Gy (17.4-21.4). With two exceptions, histology was unremarkable in animals with normal neurologic status while all animals with motor deficits showed some degree of demyelination and focal white matter necrosis on the irradiated side with relative sparing of the gray matter. Histologic comparison with a companion study of de novo irradiated animals revealed retreatment responders have more extensive tissue damage, including infarction of the gray matter, only at prescription doses >20Gy. Pigs receiving spinal radiosurgery one year following 30Gy in 10 fractions are not at significantly higher risk of developing motor deficits than pigs that have received radiosurgery alone.
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发表时间：
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影响因子：
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DOI：
10.1016/j.ijrobp.2010.07.1979
发表时间：
2011-01-01
影响因子：
7
作者：
Medin, Paul M.;Foster, Ryan D.;Solberg, Timothy D.
通讯作者：
Solberg, Timothy D.