Lhermitte Sign After Chemo-IMRT of Head-and-Neck Cancer: Incidence, Doses, and Potential Mechanisms
Lhermitte Sign After Chemo-IMRT of Head-and-Neck Cancer: Incidence, Doses, and Potential Mechanisms
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DOI：
10.1016/j.ijrobp.2011.10.052
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发表时间：
2012-08-01
影响因子：
7
通讯作者：
Eisbruch, Avraham
中科院分区：
文献类型：
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作者：
Pak, Daniel;Vineberg, Karen;Eisbruch, Avraham
目的：我们观察到头颈部癌化疗调强放疗（IMRT）后Lhermitte征（LS）的发生率高于常规放疗后的已发表发生率。我们假设，IMRT产生的不均匀的脊髓剂量分布引起了“洗澡和淋浴”的效果，其特点是在高剂量附近的低剂量，减少脊髓tolerance.Methods和材料：73例鳞状细胞癌的口咽部参与了一项前瞻性研究IMRT同时与每周卡铂和紫杉醇。其中，15例（21%）在至少2次连续随访访视期间报告LS。平均剂量、最大剂量、部分体积和绝对体积接受特定剂量的脊髓（单位：毫升）（≥ 10戈伊、≥ 20戈伊、≥ 30戈伊和≥ 40戈伊），以及“解剖”脊髓的剂量分布模式（从颅底到主动脉弓）和“计划相关”脊髓（从计划靶体积的顶部到底部），在LS患者和34名非LS患者之间进行比较。与非LS患者相比，LS患者接受30戈伊或更高和40戈伊或更高的脊髓平均剂量、V-30、V-40和绝对体积显著更高（p < 0.05）。LS的最强预测因子是接受40戈伊或更高剂量的较高V-40和较高的脐带体积（p
Purpose: We have observed a higher rate of Lhermitte sign (LS) after chemo-intensity-modulated radiotherapy (IMRT) of head-and-neck cancer than the published rates after conventional radiotherapy. We hypothesized that the inhomogeneous spinal cord dose distributions produced by IMRT caused a "bath-and-shower" effect, characterized by low doses in the vicinity of high doses, reducing spinal cord tolerance.Methods and Materials: Seventy-three patients with squamous cell carcinoma of the oropharynx participated in a prospective study of IMRT concurrent with weekly carboplatin and paclitaxel. Of these, 15 (21%) reported LS during at least 2 consecutive follow-up visits. Mean dose, maximum dose, and partial volume and absolute volume (in milliliters) of spinal cord receiving specified doses (>= 10 Gy, >= 20 Gy, >= 30 Gy, and >= 40 Gy), as well as the pattern of dose distributions at the "anatomic" spinal cord (from the base of the skull to the aortic arch) and "plan-related" spinal cord (from the top through the bottom of the planning target volumes), were compared between LS patients and 34 non-LS patients.Results: LS patients had significantly higher spinal cord mean doses, V-30, V-40, and absolute volumes receiving 30 Gy or more and 40 Gy or more compared with the non-LS patients (p < 0.05). The strongest predictors of LS were higher V-40 and higher cord volumes receiving 40 Gy or more (p