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Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer

Lhermitte-Zeichen und Myelopathie nach Bestrahlung des zervikalen Rückenmarks bei Strahlentherapie von Kopf-Hals-Tumoren


Background and purpose

The goal of this work was to examine toxicity and risk factors after irradiation of the cervical spinal cord.

Patients and methods

A total of 437 patients irradiated for a laryngeal and oropharyngeal carcinoma were eligible (median follow-up 27 months). Spinal cord contouring was defined differently over time as anatomically defined spinal cord area (SCA) and the spinal cord on CT (SC) with a margin of 3 or 5 mm (SCP3/SCP5).


None developed chronic progressive radiation myelopathy (CPRM) (maximum spinal dose 21.8–69 Gy); 3.9% (17/437) developed a Lhermitte sign (LS) with a median duration of 6 months (range 1–30 months) and was reversible in all patients. Risk factors for developing LS were younger age (52 vs. 61 years, p < 0.001), accelerated RT (12/17 patients, p < 0.005), and dose–volume relationships for SCA with ≥ 45 Gy of 14.15 cm3 and 7.9 cm3 for patients with and without LS, respectively.


LS is more frequently observed in younger patients and in patients treated with accelerated radiotherapy. A dose–volume relationship was seen for V45 in the case of SCA. For higher doses, no clear dose–volume relationships were observed.


Hintergrund und Ziel

Untersuchung von Toxizität und Risikofaktoren nach Bestrahlung des zervikalen Rückenmarks.

Patienten und Methoden

Daten von 437 Patienten mit einem Larynx- oder Oropharynxkarzinom wurden untersucht (mediane Nachbeobachtungszeit 27 Monate). Die Rückenmarkkonturierung veränderte sich im Laufe der Zeit: zuerst anatomisch definiert (SCA), später CT-basiert (SC) mit einem Sicherheitssaum von 3 oder 5 mm (SCP3/SCP5).


Es wurde keine progressive radiogene Myelopathie (CPRM) beobachtet (max. Myelondosis 21,8–69,0 Gy); 3,9% (17/437 Patienten) entwickelten ein Lhermitte-Zeichen (LS) mit einer medianen Dauer von 6 Monaten (1–30 Monaten), das bei allen Patienten reversibel war. Risikofaktoren für die Entwicklung des LS waren jüngeres Alter (52 vs. 61 Jahre, p < 0,001), akzelerierte RT (12/17 Patienten; p < 0,005) (Tab. 2) und Dosis-Volumen-Beziehungen für SCA von  ≥ 45 Gy für  > 14,15 cm3 versus 7,9 cm3 (Tab. 3, Fig. 1).


LS wird häufiger bei jüngeren Patienten und nach akzelerierter Strahlentherapie gesehen. Eine Dosis-Volumen-Beziehung wurde bei der SCA für das V45 dokumentiert. Fϋr höhere Bestrahlungsdosen wurden keine Dosis-Volumen-Beziehungen dokumentiert.

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Fig. 1


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We thank Elisabeth H.J.A. Dekkers, MSc, for providing the medical records and her overall assistance and the Department of Radiation Oncology (MAASTRO), the Netherlands.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Correspondence to B.G. Baumert MD PhD.

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Mul, V., de Jong, J., Murrer, L. et al. Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer. Strahlenther Onkol 188, 71–76 (2012).

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