Repeat reirradiation of the spinal cord: multi-national expert treatment recommendations.
Strahlenther Onkol
; 194(5): 365-374, 2018 05.
Article
em En
| MEDLINE
| ID: mdl-29362835
ABSTRACT
BACKGROUND:
Improved survival of patients with spinal bone metastases has resulted in an increased number of referrals for retreatment and repeat reirradiation.METHODS:
A consortium of expert radiation oncologists (RO) has been established with the aim of providing treatment recommendations for challenging clinical scenarios for which there are no established guidelines. In this case, a patient developed local progression of a T5 vertebral lesion after two prior courses of palliative radiotherapy (time interval >12 months, assumed cumulative biologically equivalent dose in 2Gy fractions [EQD2] for spinal cord [alpha/beta 2â¯Gy] 75â¯Gy). Expert recommendations were tabulated with the aim of providing guidance.RESULTS:
Five of seven RO would offer a third course of radiotherapy, preferably with advanced techniques such as stereotactic radiotherapy. However, the dose-fractionation concepts were heterogeneous (3-20 fractions) and sometimes adjusted to different options for systemic treatment. All five RO would compromise target volume coverage to reduce the dose to the spinal cord. Definition of the spinal cord planning-organ-at-risk volume was heterogeneous. All five RO limited the EQD2 for spinal cord. Two were willing to accept more than 12.5â¯Gy and the highest EQD2 was 19â¯Gy.CONCLUSIONS:
The increasing body of literature about bone metastases and spinal cord reirradiation has encouraged some expert RO to offer palliative reirradiation with cumulative cord doses above 75â¯Gy EQD2; however, no consensus was achieved. Strategies for harmonization of clinical practice and development of evidence-based dose constraints are discussed.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Competência Profissional
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Neoplasias da Coluna Vertebral
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Carcinoma de Células Renais
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Colaboração Intersetorial
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Comunicação Interdisciplinar
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Reirradiação
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Neoplasias Renais
Tipo de estudo:
Guideline
Limite:
Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article