REIRRADIATION HUMAN SPINAL CORD TOLERANCE FOR STEREOTACTIC BODY RADIOTHERAPY
REIRRADIATION HUMAN SPINAL CORD TOLERANCE FOR STEREOTACTIC BODY RADIOTHERAPY
复制标题
DOI：
10.1016/j.ijrobp.2010.08.021
复制
发表时间：
2012-01-01
影响因子：
7
通讯作者：
Larson, David A.
中科院分区：
文献类型：
--
作者：
Sahgal, Arjun;Ma, Lijun;Larson, David A.
目的：我们回顾了最初接受常规外照射 (EBRT) 并接受 1-5 次立体定向全身放射治疗 (SBRT) 再次照射的脊柱转移瘤患者的治疗，这些患者随后发生或未发生放射性脊髓病 (RM)。方法和材料：5 名 RM 患者（5 个脊柱节段）和 14 名非 RM 患者（16 个脊柱节段）的脊髓剂量体积直方图 (DVH) 基于鞘囊轮廓复治时。回顾了鞘囊内接受最大剂量 (P-max) 的点的剂量，以及鞘囊内 0.1、1.0 和 2.0 cc 体积的剂量。使用 α/β = 2 Gy 计算晚期脊髓毒性的生物有效剂量 (BED)，并将其标准化为 2 Gy 等效剂量 (nBED = Gy(2/2))。 结果：初始常规放疗 nBED 范围约为 30 至 50 Gy(2/2)（中位值类似于 40 Gy(2/2)）。 no-RM 组的 SBRT 再照射鞘囊平均 P-max nBED 为 20.0 Gy(2/2)（95% 置信区间 [CI], 10.8-29.2），显着低于 RM 组相应的 67.4 Gy(2/2)（95% CI, 51.0-83.9）。 no-RM组的平均总P-max nBED为62.3 Gy(2/2) (95% CI, 50.3-74.3)，显着低于101组相应的105.8 Gy(2/2) (95% CI, 84.3-127.4)。 RM 患者的 SBRT P-max nBED 占总 P-max nBED 的比例为 0.54 至 0.78，无 RM 患者的 P-max nBED 占总 P-max nBED 的比例为 0.54 至 0.78，无 RM 患者的比例为 0.04 至 0.53。结论：传统姑息性放疗后至少 5 个月进行 SBRT，再照射鞘囊 P-max nBED 为 20-25 Gy(2/2)如果总 P-max nBED 不超过约 70 Gy(2/2)，并且 SBRT 鞘囊 P-max nBED 不超过总 nBED 的约 50%，则似乎是安全的。 (C) 2012 爱思唯尔公司。
Purpose: We reviewed the treatment for patients with spine metastases who Initially received conventional external beam radiation (EBRT) and were reirradiated with 1-5 fractions of stereotactic body radiotherapy (SBRT) who did or did not subsequently develop radiation myelopathy (RM).Methods and Materials: Spinal cord dose-volume histograms (DVHs) for 5 RM patients (5 spinal segments) and 14 no-RM patients (16 spine segments) were based on thecal sac contours at retreatment. Dose to a point within the thecal sac that receives the maximum dose (P-max), and doses to 0.1-, 1.0-, and 2.0-cc volumes within the thecal sac were reviewed. The biologically effective doses (BED) using alpha/beta = 2 Gy for late spinal cord toxicity were calculated and normalized to a 2-Gy equivalent dose (nBED = Gy(2/2)).Results: The initial conventional radiotherapy nBED ranged from similar to 30 to 50 Gy(2/2) (median similar to 40 Gy(2/2)). The SBRT reirradiation thecal sac mean P-max nBED in the no-RM group was 20.0 Gy(2/2) (95% confidence interval [CI], 10.8-29.2), which was significantly lower than the corresponding 67.4 Gy(2/2) (95% CI, 51.0-83.9) in the RM group. The mean total P-max nBED in the no-RM group was 62.3 Gy(2/2) (95% CI, 50.3-74.3), which was significantly lower than the corresponding 105.8 Gy(2/2) (95% CI, 84.3-127.4) in the 101 group. The fraction of the total P-max nBED accounted for by the SBRT P-max nBED for the RM patients ranged from 0.54 to 0.78 and that for the no-RM patients ranged from 0.04 to 0.53.Conclusions: SBRT given at least 5 months after conventional palliative radiotherapy with a reirradiation thecal sac P-max nBED of 20-25 Gy(2/2) appears to be safe provided the total P-max nBED does not exceed approximately 70 Gy(2/2), and the SBRT thecal sac P-max nBED comprises no more than approximately 50% of the total nBED. (C) 2012 Elsevier Inc.