Abstract
Spinal cord dose parameters to minimize the risk of radiation myelopathy are relatively well-defined in the conventionally fractionated setting, but remain controversial for the high dose-per-fraction, partial-cord dosimetry encountered in stereotactic radiosurgery (SRS). Myelopathy has been only rarely described in the setting of SRS, and a variety of suggested dose constraints exist in the literature, ranging from a maximum cord dose (cord Dmax) of 10 to 14 Gy or a partial volume tolerance of 10 Gy (V10) to 10% of the contoured cord. Ever-improving attempts at normal tissue complication probability (NCTP) modeling permit estimation of the potential toxicity of high dose-per-fraction regimens, while animal models provide additional insights on a partial cord volume tolerance model for radiation myelopathy and suggest regional differences in radiation sensitivity across the spinal cord. The literature to date contains only ten reported cases of SRS-induced myelopathy; however, with increasing use of SRS for both benign and metastatic lesions of the spine, refining our understanding of the tolerance of the human spinal cord to hypofractionated dosimetry remains crucial.
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Daly, M.E., Gibbs, I.C. (2012). Spinal Radiosurgery: Delayed Radiation-Induced Myelopathy. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 6. Tumors of the Central Nervous System, vol 6. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2866-0_17
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