Re-irradiation of the human spinal cord

Peter Sminia, Foppe Oldenburger, Ben J Slotman, Christoph J Schneider, Maarten C C M Hulshof

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimens were designed for eight patients who required palliative radiotherapy. As a consequence of re-irradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented.

PATIENTS AND METHOD: Eight patients were re-irradiated on the cervical (n = 1), thoracic (n = 5) and lumbar (n = 2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity (alpha/beta ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BEDtolerance of 100 Gy and 84 Gy, respectively.

RESULTS: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BEDtolerance. During follow-up, ranging from 33 days to > 4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive.

CONCLUSION: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans.

Original languageEnglish
Pages (from-to)453-6
Number of pages4
JournalStrahlentherapie und Onkologie
Volume178
Issue number8
Publication statusPublished - Aug 2002

Cite this

Sminia, P., Oldenburger, F., Slotman, B. J., Schneider, C. J., & Hulshof, M. C. C. M. (2002). Re-irradiation of the human spinal cord. Strahlentherapie und Onkologie, 178(8), 453-6.
Sminia, Peter ; Oldenburger, Foppe ; Slotman, Ben J ; Schneider, Christoph J ; Hulshof, Maarten C C M. / Re-irradiation of the human spinal cord. In: Strahlentherapie und Onkologie. 2002 ; Vol. 178, No. 8. pp. 453-6.
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abstract = "PURPOSE: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimens were designed for eight patients who required palliative radiotherapy. As a consequence of re-irradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented.PATIENTS AND METHOD: Eight patients were re-irradiated on the cervical (n = 1), thoracic (n = 5) and lumbar (n = 2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity (alpha/beta ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BEDtolerance of 100 Gy and 84 Gy, respectively.RESULTS: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172{\%} of the BEDtolerance. During follow-up, ranging from 33 days to > 4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive.CONCLUSION: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans.",
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Sminia, P, Oldenburger, F, Slotman, BJ, Schneider, CJ & Hulshof, MCCM 2002, 'Re-irradiation of the human spinal cord' Strahlentherapie und Onkologie, vol. 178, no. 8, pp. 453-6.

Re-irradiation of the human spinal cord. / Sminia, Peter; Oldenburger, Foppe; Slotman, Ben J; Schneider, Christoph J; Hulshof, Maarten C C M.

In: Strahlentherapie und Onkologie, Vol. 178, No. 8, 08.2002, p. 453-6.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Re-irradiation of the human spinal cord

AU - Sminia, Peter

AU - Oldenburger, Foppe

AU - Slotman, Ben J

AU - Schneider, Christoph J

AU - Hulshof, Maarten C C M

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N2 - PURPOSE: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimens were designed for eight patients who required palliative radiotherapy. As a consequence of re-irradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented.PATIENTS AND METHOD: Eight patients were re-irradiated on the cervical (n = 1), thoracic (n = 5) and lumbar (n = 2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity (alpha/beta ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BEDtolerance of 100 Gy and 84 Gy, respectively.RESULTS: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BEDtolerance. During follow-up, ranging from 33 days to > 4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive.CONCLUSION: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans.

AB - PURPOSE: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimens were designed for eight patients who required palliative radiotherapy. As a consequence of re-irradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented.PATIENTS AND METHOD: Eight patients were re-irradiated on the cervical (n = 1), thoracic (n = 5) and lumbar (n = 2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity (alpha/beta ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BEDtolerance of 100 Gy and 84 Gy, respectively.RESULTS: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BEDtolerance. During follow-up, ranging from 33 days to > 4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive.CONCLUSION: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans.

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KW - Carcinoma, Renal Cell

KW - Carcinoma, Small Cell

KW - Cervical Vertebrae

KW - Dose Fractionation

KW - Follow-Up Studies

KW - Hodgkin Disease

KW - Humans

KW - Kidney Neoplasms

KW - Linear Models

KW - Lumbar Vertebrae

KW - Lung Neoplasms

KW - Palliative Care

KW - Radiotherapy Dosage

KW - Sarcoma, Ewing

KW - Spinal Cord/radiation effects

KW - Thoracic Vertebrae

KW - Thymoma

KW - Thymus Neoplasms

KW - Time Factors

M3 - Article

VL - 178

SP - 453

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JO - Strahlentherapie und Onkologie

JF - Strahlentherapie und Onkologie

SN - 0179-7158

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Sminia P, Oldenburger F, Slotman BJ, Schneider CJ, Hulshof MCCM. Re-irradiation of the human spinal cord. Strahlentherapie und Onkologie. 2002 Aug;178(8):453-6.