Supportive Care in Cancer

, Volume 26, Issue 6, pp 1897–1903 | Cite as

Digestive toxicities after palliative three-dimensional conformal radiation therapy (3D-CRT) for cervico-thoracic spinal metastases

  • Guillaume PeyragaEmail author
  • Delphine Caron
  • Thibaut Lizee
  • Yann Metayer
  • Anne-Lise Septans
  • Yoann Pointreau
  • Fabrice Denis
  • Gerard Ganem
  • Cedrik Lafond
  • Sophie Roche
  • Olivier Dupuis
Original Article



The palliative treatment for cervico-thoracic spinal metastases is based on a three-dimensional conformal radiation therapy (3D-CRT). Digestive toxicities are common and cause a clinical impact frequently underestimated in patients. We performed a retrospective study of digestive side effects occurring after palliative 3D-CRT for cervico-thoracic spinal metastases.

Patients and methods

All patients receiving palliative 3D-CRT at Jean Bernard Center from January 2013 to December 2014 for spinal metastases between the 5th cervical vertebra (C5) and the 12th thoracic vertebra (T12) were eligible. Three-dimensional conformal RT was delivered by a linear accelerator (CLINAC, Varian). Premedication to prevent digestive toxicities was not used. Adverse events (“esophagitis” and “nausea and/or vomiting”) were evaluated according to the NCI-CTCae (version 4).


From January 2013 to December 2014, 128 patients met the study criteria. The median age was 68.6 years [31.8; 88.6]. Most patients (84.4%) received 30 Gy in 10 fractions. The median overall time of treatment was 13 days [3–33]. Forty patients (31.3%) suffered from grade ≥ 2 of “esophagitis” (35 grade 2 (27.4%) and 5 grade 3 (3.9%)). Eight patients (6.3%) suffered from grade ≥ 2 of “nausea and/or vomiting” (6 grade 2 (4.7%), 1 grade 3 (0.8%), and 1 grade 4 (0.8%)).


The high incidence of moderate to severe digestive toxicities after palliative 3D-CRT for cervico-thoracic spinal metastases led to consider static or dynamic intensity-modulated radiation therapy (IMRT) to reduce the dose to organ at risk (the esophagus and stomach). Dosimetric studies and implementation in the clinic should be the next steps.


Radio-induced esophagitis Esophageal toxicities Digestive toxicities Intensity-modulated radiation therapy Spinal metastases 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Guillaume Peyraga
    • 1
    • 2
    Email author
  • Delphine Caron
    • 1
    • 2
  • Thibaut Lizee
    • 1
    • 2
  • Yann Metayer
    • 3
  • Anne-Lise Septans
    • 4
  • Yoann Pointreau
    • 1
  • Fabrice Denis
    • 1
  • Gerard Ganem
    • 1
  • Cedrik Lafond
    • 1
  • Sophie Roche
    • 1
  • Olivier Dupuis
    • 1
  1. 1.Department of Radiation TherapyJean Bernard CenterLe MansFrance
  2. 2.Department of Radiation TherapyIntegrative Center of Oncology (Paul Papin)Angers Cedex 2France
  3. 3.Department of Medical PhysicsJean Bernard CenterLe MansFrance
  4. 4.Department of Medical BiostatisticsJean Bernard CenterLe MansFrance

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