Repeat reirradiation of the spinal twine: multi-national skilled therapy 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 skilled radiation oncologists (RO) has been established with the purpose of offering therapy suggestions for difficult medical situations for which there are not any established pointers. 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 twine [alpha/beta 2?Gy] 75?Gy). Professional suggestions had been tabulated with the purpose of offering steerage.
RESULTS: 5 of seven RO would provide a third course of radiotherapy, ideally with superior strategies similar to stereotactic radiotherapy. Nonetheless, the dose-fractionation ideas had been heterogeneous (Three-20 fractions) and typically adjusted to completely different choices for systemic therapy. All 5 RO would compromise goal quantity protection to scale back the dose to the spinal twine. Definition of the spinal twine planning-organ-at-risk quantity was heterogeneous. All 5 RO restricted the EQD2 for spinal twine. Two had been keen to simply accept greater than 12.5?Gy and the very best EQD2 was 19?Gy.
CONCLUSIONS: The rising physique of literature about bone metastases and spinal twine reirradiation has inspired some skilled RO to supply palliative reirradiation with cumulative twine doses above 75?Gy EQD2; nevertheless, no consensus was achieved. Methods for harmonization of medical follow and growth of evidence-based dose constraints are mentioned.
PMID: 29362835 [PubMed – indexed for MEDLINE]