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Spinal Cord Tolerance and Risk of Radiation Myelopathy

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Adult CNS Radiation Oncology

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Abstract

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.

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Conflicts of Interest

Arjun Sahgal: Grants from Elekta AB and educational honoraria from previous educational seminars from Elekta AB, Varian Medical Systems, Accuray and Medtronic kyphoplasty division.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Majed Alghamdi

  2. Faculty of Medicine, Al Baha University, Al Baha, Saudi Arabia

    Majed Alghamdi

  3. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Shun Wong, Young Lee, Sten Myrehaug, Chia-Lin Tseng, Hany Soliman & Arjun Sahgal

  4. Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA

    Paul Medin

  5. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA

    Lijun Ma & David A. Larson

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  1. Majed Alghamdi
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Correspondence to Arjun Sahgal .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, Keck School of Medicine of USC, Norris Cancer Hospital, Los Angeles, California, USA

    Eric L. Chang

  2. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA

    Paul D. Brown

  3. Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, USA

    Simon S. Lo

  4. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Arjun Sahgal

  5. Department of Radiation Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio, USA

    John H. Suh

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Alghamdi, M. et al. (2018). Spinal Cord Tolerance and Risk of Radiation Myelopathy. In: Chang, E., Brown, P., Lo, S., Sahgal, A., Suh, J. (eds) Adult CNS Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42878-9_37

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  • DOI: https://doi.org/10.1007/978-3-319-42878-9_37

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-42878-9

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