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CT-Myelography for High-Dose Irradiation of Spinal and Paraspinal Tumors with Helical Tomotherapy

Revival of an Old Tool

Wiederentdeckung eines alten Werkzeugs: CT-Myelographie für die Hochdosisbestrahlung von spinalen und paraspinalen Tumoren mit der helikalen Tomotherapie

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Background and Purpose:

High-dose irradiation or reirradiation of spinal and paraspinal tumors is a challenge particularly in the presence of metal artifacts after surgery. Image-guided advanced intensity-modulated radiotherapy delivers high-dose radiation to the tumor sparing the spinal cord. Precise delineation of the spinal cord is necessary treating para- and intraspinal tumors with a sufficient dose.

Patients and Methods:

The use of myelo-CT was evaluated in 23 patients with spinal and paraspinal tumors. All patients had had previous surgery with metal implants in the radiation area. All patients had an indication for high-dose irradiation. Treatment planning was performed using nonenhanced and contrast-enhanced myelo-CT in the same position and immobilization and both CT scans were matched. Treatment was performed by using a tomotherapy treatment unit.

Results:

Contouring of the myelon in all slices of the myelo-CT was possible in 20 of 23 patients. All these patients were treated with doses of median 69.4 Gy in 2 Gy/1.8 Gy single doses using daily image guidance. One patient received an integrated boost with a TD/SD of 70/2.3 Gy. No side effects have been observed so far during a median follow-up of 15.5 months. No separation between tumor and myelon could be observed in 3 patients.

Conclusion:

Myelo-CT offers a distinct delineation of the myelon and the paraspinal tumor in case of artifacts due to metal implants after surgery. Using this tool in combination with advanced image guidance and IMRT techniques, patients with relatively radioresistent paraspinal tumors might have the chance of improved local control using higher target doses.

Hintergrund:

Hochdosisbestrahlung oder Rebestrahlung von spinalen und paraspinalen Tumoren ist eine Herausforderung, besonders in Gegenwart von Metallartefakten nach Operation. Bildgeführte intensitätsmodulierte Radiotherapie liefert eine hohe Strahlendosis auf den Tumor unter Schonung des Rückenmarks. Daher ist eine genaue Abgrenzung des Rückenmarks notwendig, um die Behandlung para- und intraspinaler Tumoren mit einer ausreichenden Dosis durchführen zu können.

Patienten und Methoden:

Die Verwendung eines Myelo-CT wurde bei 23 Patienten mit spinalen und paraspinalen Tumoren untersucht. Alle Patienten hatten Voroperationen mit Metallimplantaten im Bestrahlungsbereich. Alle Patienten hatten eine Indikation zur Hochdosisbestrahlung. Die Bestrahlungsplanung erfolgte mit einem nativen CT und einem Myelo-CT in gleicher Lagerung und Immobilisation. Die beiden CT-Scans wurden fusioniert. Die Bestrahlung erfolgte mittels einer Tomotherapieeinheit.

Ergebnisse:

Die Konturierung des Myelon in allen Schichten des Myelo-CT war bei 20/23 Patienten möglich. Alle diese Patienten wurden erfolgreich mit einer medianen Dosis von 69.4 Gy in 2-Gy-/1,8-Gy-Einzeldosen behandelt. Ein Patient erhielt einen integrierten Boost mit einer GD/ED von 70/2,3 Gy. Bei einem medianen Follow-up von 15,5 Monaten wurden keine Nebenwirkungen der Behandlung festgestellt. Eine Abgrenzung des Myelon vom Tumorgewebe war bei 3 Patienten nicht möglich.

Schlussfolgerung:

Das Myelo-CT führt zu einer deutlichen Abgrenzbarkeit des Myelons von paraspinalen und spinalen Tumoren bei Metallartefakten nach Operation. Mit diesem Werkzeug in Kombination mit modernen IMRT-Techniken, könnte eine Verbesserung der Lokalrezidivrate bei Patienten mit relativ radioresistenten paraspinalen Tumoren erreicht werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany

    Matthias Uhl Dr. med., Florian Sterzing, Gregor Habl, Kai Schubert, Gabriele Sroka-Perez, Jürgen Debus & Klaus Herfarth

  2. Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Matthias Uhl Dr. med.

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  1. Matthias Uhl Dr. med.
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  2. Florian Sterzing
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  3. Gregor Habl
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  4. Kai Schubert
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  6. Jürgen Debus
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Correspondence to Matthias Uhl Dr. med..

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Uhl, M., Sterzing, F., Habl, G. et al. CT-Myelography for High-Dose Irradiation of Spinal and Paraspinal Tumors with Helical Tomotherapy. Strahlenther Onkol 187, 416–420 (2011). https://doi.org/10.1007/s00066-011-2219-5

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  • DOI: https://doi.org/10.1007/s00066-011-2219-5

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