Abstract
Where there is a rapid repopulation of tumor clonogens, a gain in local control should be realized by administering radiation treatments in a shorter overall time, thereby reducing the opportunity for proliferation of tumor cells during the treatment. Because of the differential effect of fractionation in early-versus late-responding normal tissues, decreased overall treatment time must be done in the context of keeping the fraction size small. The only feasible approach is to administer multiple fractions per day and use short interfraction intervals. Provided repair of sublethal radiation damage is largely complete within the interfraction interval, excessive late morbidity would not be expected. These radiobiological rationales of accelerated hyperfractionated radiotherapy thus suggest an altered fractionation scheme in which the overall treatment time is reduced, the dose per fraction is reduced, and multiple fractions are given per day.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Abbatucci JS, Delozier T, Quint R, Roussel A, Brune D (1978) Radiation myelopathy of the cervical spinal cord: time, dose and volume factors. Int J Radiat Oncol Biol Phys 4: 239–248
Ang KK, van der Kogel AJ, van der Schueren E (1985) Lack of evidence for increased tolerance of rat spinal cord with decreasing fraction doses below 2 Gy. Int J Radiat Oncol Biol Phys 11: 105–110
Ang KK, Thames HD, van der Kogel Ai, van der Schueren E (1987) Is the rate of repair of radiation-induced sublethal damage in rat spinal cord dependent on the size of dose per fraction? Int J Radiat Oncol Biol Phys 13: 557–562
Ang KK, Jiang GL, Thames HD, Stephens LC (1990) Repair kinetics in rat spinal cord (abstract). In: Proceedings of the 38th annual meeting of the Radiation Research Society, New Orleans, p 113
Dische S (1991) Accelerated treatment and radiation myelitis. Radiother Oncol 20: 1–2
Dische S, Saunders MI (1989) Continuous, hyperfractionated, accelerated radiotherapy (CHART): an interim report upon late morbidity. Radiother Oncol 6: 65–72
Dische S, Warburton MF, Saunders MI (1988) Radiation myelitis and survival in the radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys 15: 75–81
Hopewell JW, Wright EA (1970) The nature of latent cerebral irradiation damage and its modification by hypertension. Br J Radiol 43: 161–167
Joiner MC (1989) The dependence of radiation response on the dose per fraction. BIR Rep 19: 20–26
Lavey RS, Johnstone AK, Tracy JT, Taylor JMG, McBride WH (1991) Effect of hyperfractionation on “spinal cord” tolerance. Int J Radiat Oncol Biol Phys 215: 164–165
Marcus RB, Million RR (1990) The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 175: 163
McCunniff AJ, Liang MJ (1989) Radiation tolerance of the cervical spinal cord. Int J Radiat Oncol Biol Phys 16: 675–678
Peters Li, Ang KK (1986) Unconventional fractionation schemes in radiotherapy. In: DeVita V, Hellman S, Rosenberg A (eds) Important advances in oncology. Lippincott, Philadelphia, pp 269–286
Reinhold HS, Kaalen JGAH, Unger-Gils K (1976) Radiation myelopathy of the thoracic spinal cord. Int J Radiat Oncol Biol Phys 1: 651–657
Saunders MI, Dische S, Grosch EJ, Fermont DC, Ashford RFU, Maher EJ, Makepeace AR (1991) Experience with CHART. Int J Radiat Oncol Biol Phys 21: 871–878
Schultheiss TE (1990) Spinal cord radiation “tolerance”: doctrine versus data. Int J Radiat Oncol Biol Phys 19: 219–221
Schultheiss TE, Higgins EM, El-Mandi AM (1984) The latent period in clinical radiation myelopathy. Int J Radiat Oncol Biol Phys 10: 1109–1115
Thames HD (1985) An “incomplete-repair” model for survival after fractionated and continuous irradiations. Int J Radiat Biol 47: 319–339
Thames HD, Ang KK, Stewart FA, van der Schueren E (1988) Does incomplete repair explain the apparent failure of the basic LQ model to predict spinal cord and kidney responses to low doses per fraction? Int J Radiat Biol 54: 13–19
Van de Bogaert W, van der Schueren E, Horiot JC (1986) (EORTC cooperative group of radiotherapy). Early results of the EORTC randomized clinical trial on multiple fractions per day ( MFD) and misonidazole in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 12: 587–591
Van der Kogel AJ (1986) Radiation-induced damage in the central nervous system: an interpretation of target cell responses. Br J Cancer 53 [Suppl]: 207–217
Van der Kogel AJ (1989) Continuous hyperfractionated, accelerated radiotherapy. Radiother Oncol 16: 75–77
Van der Schueren E, Landuyt W, Ang KK, van der Kogel AJ (1988) From 2 Gy to 1 Gy per fraction: sparing effect in rat spinal cord? Int J Radiat Oncol Biol Phys 14: 297–300
Wara WM, Phillips TL, Sheline GE, Schwarde JG (1975) Radiation tolerance of the spinal cord. Cancer 35: 1558–1562
Wong CS, van Dyk J, Simpson WJ (1991) Myelopathy following hyperfractionated accelerated radiotherapy for anaplastic thyroid carcinoma. Radiother Oncol 20: 3–9
Wong CS, Minkin S, Hill RP (1992) Linear quadratic model underestimates sparing effect of small doses per fraction in rat spinal cord. Radiother Oncol 23: 176–184
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag Berlin · Heidelberg
About this paper
Cite this paper
Wong, C.S., Van Dyk, J., Hill, R.P. (1993). Myelopathy and Hyperfractionated Accelerated Radiotherapy: A Radiobiological Interpretation. In: Hinkelbein, W., Bruggmoser, G., Frommhold, H., Wannenmacher, M. (eds) Acute and Long-Term Side-Effects of Radiotherapy. Recent Results in Cancer Research, vol 130. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84892-6_16
Download citation
DOI: https://doi.org/10.1007/978-3-642-84892-6_16
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-84894-0
Online ISBN: 978-3-642-84892-6
eBook Packages: Springer Book Archive