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dc.contributor.authorDoi, Hiroshi
dc.contributor.authorTamari, Keisuke
dc.contributor.authorOh, Ryoong-Jin
dc.contributor.authorNieder, Carsten
dc.date.accessioned2021-10-26T08:37:11Z
dc.date.available2021-10-26T08:37:11Z
dc.date.issued2021-05-05
dc.description.abstract<i>Purpose</i> - To provide additional clinical data about the re-irradiation tolerance of the spinal cord.<br><br> <i>Methods</i> - This was a retrospective bi-institutional study of patients re-irradiated to the cervical or thoracic spinal cord with minimum follow-up of 6 months. The maximum dose (Dmax) and dose to 0.1cc (D0.1cc) were determined (magnetic resonance imaging [MRI]-defined cord) and expressed as equivalent dose in 2‑Gy fractions (EQD2) with an α/β value of 2 Gy.<br><br> <i>Results</i> - All 32 patients remained free from radiation myelopathy after a median follow-up of 12 months. Re-irradiation was performed after 6–97 months (median 15). In 22 cases (69%) the re-irradiation spinal cord EQD2 Dmax was higher than that of the first treatment course. Forty-eight of 64 treatment courses employed fraction sizes of 2.5 to 4 Gy to the target volume. The median cumulative spinal cord EQD2 Dmax was 80.7 Gy, minimum 61.12 Gy, maximum 114.79 Gy. The median cumulative spinal cord D0.1cc EQD2 was 76.1 Gy, minimum 61.12 Gy, maximum 95.62 Gy. Besides cumulative dose, other risk factors for myelopathy were present (single-course Dmax EQD2 ≥51 Gy in 9 patients, single-course D0.1cc EQD2 ≥51 Gy in 5 patients).<br><br> <i>Conclusion</i> - Even patients treated to higher cumulative doses than previously recommended, or at a considerable risk of myelopathy according to a published risk score, remained free from this complication, although one must acknowledge the potential for manifestation of damage in patients currently alive, i.e., still at risk. Individualized decisions to re-irradiate after appropriate informed consent are an acceptable strategy, including scenarios where low re-irradiation doses to the spinal cord would compromise target coverage and tumor control probability to an unacceptable degree.en_US
dc.identifier.citationDoi, Tamari, Oh, Nieder. New clinical data on human spinal cord re-irradiation tolerance. Strahlentherapie und Onkologie (Print). 2021;197:463-473en_US
dc.identifier.cristinIDFRIDAID 1916720
dc.identifier.doi10.1007/s00066-021-01772-7
dc.identifier.issn0179-7158
dc.identifier.issn1439-099X
dc.identifier.urihttps://hdl.handle.net/10037/22826
dc.language.isoengen_US
dc.publisherSpringeren_US
dc.relation.journalStrahlentherapie und Onkologie (Print)
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2021 The Author(s)en_US
dc.subjectVDP::Medical disciplines: 700en_US
dc.subjectVDP::Medisinske Fag: 700en_US
dc.titleNew clinical data on human spinal cord re-irradiation toleranceen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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