Repeat reirradiation of the spinal wire: multi-national knowledgeable remedy suggestions.
Strahlenther Onkol. 2018 05;194(5):365-374
Authors: Nieder C, Gaspar LE, Ruysscher D, Guckenberger M, Mehta MP, Rusthoven CG, Sahgal A, Gkika E
BACKGROUND: Improved survival of sufferers with spinal bone metastases has resulted in an elevated variety of referrals for retreatment and repeat reirradiation.
METHODS: A consortium of knowledgeable radiation oncologists (RO) has been established with the intention of offering remedy suggestions for difficult medical situations for which there are not any established tips. On this case, a affected person developed native development of a T5 vertebral lesion after two prior programs of palliative radiotherapy (time interval >12 months, assumed cumulative biologically equal dose in 2?Gy fractions [EQD2] for spinal wire [alpha/beta 2?Gy] 75?Gy). Knowledgeable suggestions had been tabulated with the intention of offering steering.
RESULTS: 5 of seven RO would provide a third course of radiotherapy, ideally with superior methods reminiscent of stereotactic radiotherapy. Nonetheless, the dose-fractionation ideas had been heterogeneous (Three-20 fractions) and typically adjusted to completely different choices for systemic remedy. All 5 RO would compromise goal quantity protection to scale back the dose to the spinal wire. Definition of the spinal wire planning-organ-at-risk quantity was heterogeneous. All 5 RO restricted the EQD2 for spinal wire. Two had been keen to just accept greater than 12.5?Gy and the best EQD2 was 19?Gy.
CONCLUSIONS: The rising physique of literature about bone metastases and spinal wire reirradiation has inspired some knowledgeable RO to supply palliative reirradiation with cumulative wire doses above 75?Gy EQD2; nevertheless, no consensus was achieved. Methods for harmonization of medical observe and growth of evidence-based dose constraints are mentioned.
PMID: 29362835 [PubMed – indexed for MEDLINE]