Founded in 1993
  Year: 2000 | Volume: 8 | Issue: 3 | Pages: 131-134
  Review Article
  RADIATION TOLERANCE OF THE SPINAL CORD: DOCTRINE DOGMAS, DATA
Lilia GOCHEVA
  DOI:
  Abstract:
  Radiation damage to the spinal cord is one of the most feared complications in the treatment of cancer with radiation therapy. There is no uniformly accepted definition of the term #tolerance# and this fact reflects differences in the clinical acceptability of the types of treatment related morbidity. Having in mind this fact, to say a dose to the spinal cord of 45 Gy in 23-25 fraction represents cord tolerance, is true only insofar as most radiotherapists accept its use and very few will tolerate in practice a higher dose. Many studies have attempted to define the risk factors associated with chronic progressive radiation myelopathy with differing conclusions. In the present paper the following main factors are discussed in detail: total dose, dose per fraction, length (volume) of the spinal cord irradiated segment of spinal cord and reirradiation of the cord to control the malignant disease. A number of conclusions are obtained regarding the relative influence of these risk factors, particularly for the range of doses usually given incidentally to the spinal cord in the treatment of tumors in the region of the cord. It is obvious that the sample size in the clinical studies is not adequate to define the multiple risk factors of chronic progressive radiation myelopathy. In fact, the sample size required, may be so large that the exact risks may never be completely defined. It is unfortunate that the standard of practice for limiting incidental dose to the spinal cord is determined more by ligitation than by clinical judgment. Tumoricidal dose should never be compromised for the purpose of limiting, where such liming forces even greater probability of compromising the tumoricidal dose.
  Key words: Spinal cord; Radiation tolerance; Risk factors; Radiation damage; Radiation complications
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Founder, owner and publisher: Oncology Institute of Vojvodina, Serbia
Online since 1997 (Abstracts only); 2000 (Abstracts and Full text)
ISSN: 0354-7310 eISSN: 1450-9520