Abstract
Purpose:
To perform aggressive radiotherapy for vertebral metastases. Using very steep dose gradients from intensity-modulated radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated.
Patients and Methods:
50 patients with vertebral metastases were treated using IMRT. In previously unirradiated cases, where a prescribed dose of 80 Gy (BED10) was delivered, the constraint to the spinal cord should be less than 100 Gy (BED2). For previously irradiated cases, on the other hand, the dose is the same as in the previously unirradiated case; however, constraints for the spinal cord are a cumulative BED2 of less than 150 Gy, BED2 of less than 100 Gy in each instance, and a treatment gap of more than 6 months. There were 6 patients considered for a partial volume dose to the spinal cord. They all received higher BED2, ranging from 51–157 Gy of D1cc.
Results:
Among the 24 patients who survived longer than 1 year, there was 1 case of transient radiation myelitis. There were no other cases of spinal cord sequelae.
Conclusion:
Based on the present results, we recommend a BED2 of 100 Gy or less at D1cc as a constraint for the spinal cord in previously unirradiated cases, and a cumulative BED2 of 150 Gy or less at D1cc in previously irradiated cases, when the interval was not shorter than 6 months and the BED2 for each session was 100 Gy or less. The prescribed BED10 of 80 Gy could be safely delivered to the vertebral lesions.
Zusammenfassung
Hintergrund und Ziel:
Aggressive Strahlentherapie bei vertebralen Metastasen. Unter Einsatz sehr steiler Dosisgradienten intensitätsmodulierter Strahlentherapie (IMRT) Evaluierung eines Therapieprotokolls basierend auf dem Konzept der partiellen Volumendosierung am Rückenmark.
Patienten und Methodik:
Wir behandelten mit IMRT 50 Patienten mit Wirbelsäulenmetastasen. In Fällen ohne vorangegangene Strahlentherapie, bei denen eine verordnete Dosis von 80 Gy BED10 appliziert wurde, sollte die Belastung des Rückenmarks weniger als 100 Gy BED2 betragen. In Fällen mit vorheriger Strahlentherapie wurde die gleiche Dosis appliziert, wobei allerdings die Belastung des Rückenmarks kumulativ unter 150 Gy BED2 und in der Einzelapplikation bei weniger als 100 Gy BED2 lag, außerdem die Behandlungspause mehr als 6 Monate betrug. Für die partielle Volumendosierung am Rückenmark kamen 6 Patienten in Frage. Alle erhielten die höhere BED2 von mehr als 51 Gy bis zu 157 Gy D1cc.
Ergebnisse:
Unter 24 Patienten, die länger als ein Jahr überlebten, gab es einen Fall vorübergehender Strahlenmyelitis. Es wurden keine weiteren Fälle von Bestrahlungsfolgen am Rückenmark beobachtet.
Schlussfolgerung:
Auf Basis der vorliegenden Ergebnissen würden wir eine BED2 von 100 Gy oder weniger bei D1cc am Rückenmark in Fällen ohne vorangegangene Strahlentherapie empfehlen und in Fällen mit vorheriger Strahlentherapie eine kumulative BED2 von 150 Gy oder weniger bei D1cc, wenn das Behandlungsintervall nicht kürzer als 6 Monate war und die Dosis der Einzelapplikation bei einer BED2 von 100 Gy oder weniger lag. Die verordnete Dosis einer BED10 von 80 Gy bei Wirbelsäulenläsionen ließ sich sicher applizieren.
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*This paper was presented at the 15th Workshop of German–Japanese Radiological Affiliation in Tokyo, Japan, on 23 May 2010.
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Inoue, T., Oh, RJ. & Shiomi, H. New Approach for Treatment of Vertebral Metastases Using Intensity-Modulated Radiotherapy*. Strahlenther Onkol 187, 108–113 (2011). https://doi.org/10.1007/s00066-010-2187-1
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DOI: https://doi.org/10.1007/s00066-010-2187-1