Risk of Myelopathy Following Second Local Treatment after Initial Irradiation of Spine Metastasis

Diagnostics, 2023 · DOI: 10.3390/diagnostics13020175 · Published: January 4, 2023

Simple Explanation

Spine metastasis can cause pain and neurologic issues due to spinal cord compression. Palliative radiotherapy is often the first treatment. Reirradiation can help but increases the risk of radiation-induced myelopathy (RM). This review studies local treatment options after initial radiation for relapsed spine metastasis. It looks at the risk of spinal cord injury related to reirradiation technique, dose, and timing. The review converts published doses into biologically effective doses (EQD2). It found little RM after SBRT at doses around 93.5 Gy2/2. A lack of consistency in reporting spinal cord dose makes pooling data difficult.

Study Duration

Not specified

Participants

Adult participants with vertebral tumors

Evidence Level

Review

Key Findings

1
For 3D radiotherapy, cumulative doses from 55.2 Gy2/2 to 65.5 Gy2/2 EQD2 showed no cases of radiation-induced myelopathy.
2
There was little evidence of radiation-induced myelopathy after SBRT, typically at a median reported dose to critical neural tissue around 93.5 Gy2/2.
3
The median time to reirradiation in the analyzed papers was 14 months.

Research Summary

This review highlights important issues for the reirradiation of patients with vertebral metastases, including the median time to reirradiation of 14 months. The use of highly conformal techniques in reirradiation obtained median doses to the spinal cord of 23.6 Gy2/2 versus doses around 40 Gy2/2 obtained with conformal technique in the ﬁrst course. High-precision irradiation techniques can help when constraints become difficult to achieve, enabling dose escalation for better tumor control; however, there is a need for greater rigor in terms of the treatment protocol.

Practical Implications

Treatment Planning

Use highly conformal techniques to minimize spinal cord dose during reirradiation.

Dose Monitoring

Be aware of cumulative doses to the spinal cord and adhere to dose constraints.

Standardization

Promote greater rigor and standardization in treatment protocols, modeling, prescription, and dose reporting.

Study Limitations

1
Lack of consistency in reporting the spinal cord dose.
2
Heterogeneity of histology and stage of disease.
3
Lack of full data reporting makes it impossible to compare the analysis for overall survival and efficacy.

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