Spinal Cord Tolerance and Risk of Radiation Myelopathy
摘要
Radiation myelopathy (RM) is one of the most feared complications of radiation therapy. It is a diagnosis of exclusion based on both clinical and radiographic findings. Safe spinal cord dose limits have been derived from preclinical and limited human clinical dosimetric data. The doses to the spinal cord associated with a clinically acceptable risk of RM (≤5%) vary depending on dose per fraction, technique, previous radiation treatment, and time interval between radiation courses. When appropriate spinal cord dose limits are applied, RM is considered rare event. This chapter will summarize the data, specific to both conventionally fractionated radiation (1.8–2.0 Gy/fraction) and high-dose stereotactic body radiotherapy (>5 Gy/fraction), as to spinal cord tolerance and recommendations for safe practice.