Spinal Cord Tolerance to Reirradiation With Single-Fraction Radiosurgery: A Swine Model
Purpose This study was performed to determine swine spinal cord tolerance to single-fraction, partial-volume irradiation 1 year after receiving uniform irradiation to 30 Gy in 10 fractions. Methods and Materials A 10-cm length of spinal cord (C3–T1) was uniformly irradiated to 30 Gy in 10 consecutiv...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2012-07, Vol.83 (3), p.1031-1037 |
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| creator | Medin, Paul M., Ph.D Foster, Ryan D., Ph.D van der Kogel, Albert J., Ph.D Sayre, James W., Ph.D McBride, William H., D.Sc Solberg, Timothy D., Ph.D |
| description | Purpose This study was performed to determine swine spinal cord tolerance to single-fraction, partial-volume irradiation 1 year after receiving uniform irradiation to 30 Gy in 10 fractions. Methods and Materials A 10-cm length of spinal cord (C3–T1) was uniformly irradiated to 30 Gy in 10 consecutive fractions and reirradiated 1 year later with a single radiosurgery dose centered within the previously irradiated segment. Radiosurgery was delivered to a cylindrical volume approximately 5 cm in length and 2 cm in diameter, which was positioned laterally to the cervical spinal cord, resulting in a dose distribution with the 90%, 50%, and 10% isodose lines traversing the ipsilateral, central, and contralateral spinal cord, respectively. Twenty-three pigs were stratified into six dose groups with mean maximum spinal cord doses of 14.9 ± 0.1 Gy ( n = 2), 17.1 ± 0.3 Gy ( n = 3), 19.0 ± 0.1 Gy ( n = 5), 21.2 ± 0.1 Gy ( n = 5), 23.4 ± 0.2 Gy ( n = 5), and 25.4 ± 0.4 Gy ( n = 3). The mean percentage of spinal cord volumes receiving ≥10 Gy for the same groups were 34% ± 1%, 40% ± 1%, 46% ± 3%, 52% ± 1%, 56 ± 3%, and 57% ± 1%. The study endpoint was motor neurologic deficit as determined by a change in gait during a 1- year follow-up period. Results A steep dose-response curve was observed with a 50% incidence of paralysis (ED50 ) for the maximum point dose of 19.7 Gy (95% confidence interval, 17.4–21.4). With two exceptions, histology was unremarkable in animals with normal neurologic status, while all animals with motor deficits showed some degree of demyelination and focal white matter necrosis on the irradiated side, with relative sparing of gray matter. Histologic comparison with a companion study of de novo irradiated animals revealed that retreatment responders had more extensive tissue damage, including infarction of gray matter, only at prescription doses >20 Gy. Conclusion Pigs receiving spinal radiosurgery 1 year after receiving 30 Gy in 10 fractions were not at significantly higher risk of developing motor deficits than pigs that received radiosurgery alone. |
| doi_str_mv | 10.1016/j.ijrobp.2011.08.030 |
| format | Article |
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Methods and Materials A 10-cm length of spinal cord (C3–T1) was uniformly irradiated to 30 Gy in 10 consecutive fractions and reirradiated 1 year later with a single radiosurgery dose centered within the previously irradiated segment. Radiosurgery was delivered to a cylindrical volume approximately 5 cm in length and 2 cm in diameter, which was positioned laterally to the cervical spinal cord, resulting in a dose distribution with the 90%, 50%, and 10% isodose lines traversing the ipsilateral, central, and contralateral spinal cord, respectively. Twenty-three pigs were stratified into six dose groups with mean maximum spinal cord doses of 14.9 ± 0.1 Gy ( n = 2), 17.1 ± 0.3 Gy ( n = 3), 19.0 ± 0.1 Gy ( n = 5), 21.2 ± 0.1 Gy ( n = 5), 23.4 ± 0.2 Gy ( n = 5), and 25.4 ± 0.4 Gy ( n = 3). The mean percentage of spinal cord volumes receiving ≥10 Gy for the same groups were 34% ± 1%, 40% ± 1%, 46% ± 3%, 52% ± 1%, 56 ± 3%, and 57% ± 1%. The study endpoint was motor neurologic deficit as determined by a change in gait during a 1- year follow-up period. Results A steep dose-response curve was observed with a 50% incidence of paralysis (ED50 ) for the maximum point dose of 19.7 Gy (95% confidence interval, 17.4–21.4). With two exceptions, histology was unremarkable in animals with normal neurologic status, while all animals with motor deficits showed some degree of demyelination and focal white matter necrosis on the irradiated side, with relative sparing of gray matter. Histologic comparison with a companion study of de novo irradiated animals revealed that retreatment responders had more extensive tissue damage, including infarction of gray matter, only at prescription doses >20 Gy. Conclusion Pigs receiving spinal radiosurgery 1 year after receiving 30 Gy in 10 fractions were not at significantly higher risk of developing motor deficits than pigs that received radiosurgery alone.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2011.08.030</identifier><identifier>PMID: 22197239</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Animals ; Biological and medical sciences ; Cervical Vertebrae ; Diseases of the nervous system ; Dose-Response Relationship, Radiation ; Female ; Gait Disorders, Neurologic - etiology ; HAZARDS ; Hematology, Oncology and Palliative Medicine ; HISTOLOGY ; IRRADIATION ; Medical sciences ; Myelin Sheath - pathology ; Myelin Sheath - radiation effects ; NECROSIS ; Radiation Dosage ; RADIATION DOSE DISTRIBUTIONS ; RADIATION DOSES ; RADIATION INJURIES ; Radiation Injuries, Experimental - complications ; Radiation Injuries, Experimental - pathology ; Radiation therapy and radiosensitizing agent ; Radiation Tolerance ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - adverse effects ; Radiosurgery - methods ; RADIOTHERAPY ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Reirradiation ; Retreatment ; SPINAL CORD ; Spinal Cord - pathology ; Spinal Cord - radiation effects ; Spinal cord tolerance ; Stereotactic spinal radiosurgery ; SURGERY ; SWINE ; Swine, Miniature ; Time Factors ; Treatment with physical agents ; Treatment. General aspects ; Tumors</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-07, Vol.83 (3), p.1031-1037</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><rights>2011 Elsevier Inc. All rights reserved. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-d22c9e1f214b4d25159924d38b1a47a9105a045a5db5d0e33bd4795f1d43a3c73</citedby><cites>FETCH-LOGICAL-c576t-d22c9e1f214b4d25159924d38b1a47a9105a045a5db5d0e33bd4795f1d43a3c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2011.08.030$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25982582$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22197239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22058922$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Medin, Paul M., Ph.D</creatorcontrib><creatorcontrib>Foster, Ryan D., Ph.D</creatorcontrib><creatorcontrib>van der Kogel, Albert J., Ph.D</creatorcontrib><creatorcontrib>Sayre, James W., Ph.D</creatorcontrib><creatorcontrib>McBride, William H., D.Sc</creatorcontrib><creatorcontrib>Solberg, Timothy D., Ph.D</creatorcontrib><title>Spinal Cord Tolerance to Reirradiation With Single-Fraction Radiosurgery: A Swine Model</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose This study was performed to determine swine spinal cord tolerance to single-fraction, partial-volume irradiation 1 year after receiving uniform irradiation to 30 Gy in 10 fractions. Methods and Materials A 10-cm length of spinal cord (C3–T1) was uniformly irradiated to 30 Gy in 10 consecutive fractions and reirradiated 1 year later with a single radiosurgery dose centered within the previously irradiated segment. Radiosurgery was delivered to a cylindrical volume approximately 5 cm in length and 2 cm in diameter, which was positioned laterally to the cervical spinal cord, resulting in a dose distribution with the 90%, 50%, and 10% isodose lines traversing the ipsilateral, central, and contralateral spinal cord, respectively. Twenty-three pigs were stratified into six dose groups with mean maximum spinal cord doses of 14.9 ± 0.1 Gy ( n = 2), 17.1 ± 0.3 Gy ( n = 3), 19.0 ± 0.1 Gy ( n = 5), 21.2 ± 0.1 Gy ( n = 5), 23.4 ± 0.2 Gy ( n = 5), and 25.4 ± 0.4 Gy ( n = 3). The mean percentage of spinal cord volumes receiving ≥10 Gy for the same groups were 34% ± 1%, 40% ± 1%, 46% ± 3%, 52% ± 1%, 56 ± 3%, and 57% ± 1%. The study endpoint was motor neurologic deficit as determined by a change in gait during a 1- year follow-up period. Results A steep dose-response curve was observed with a 50% incidence of paralysis (ED50 ) for the maximum point dose of 19.7 Gy (95% confidence interval, 17.4–21.4). With two exceptions, histology was unremarkable in animals with normal neurologic status, while all animals with motor deficits showed some degree of demyelination and focal white matter necrosis on the irradiated side, with relative sparing of gray matter. Histologic comparison with a companion study of de novo irradiated animals revealed that retreatment responders had more extensive tissue damage, including infarction of gray matter, only at prescription doses >20 Gy. Conclusion Pigs receiving spinal radiosurgery 1 year after receiving 30 Gy in 10 fractions were not at significantly higher risk of developing motor deficits than pigs that received radiosurgery alone.</description><subject>Animals</subject><subject>Biological and medical sciences</subject><subject>Cervical Vertebrae</subject><subject>Diseases of the nervous system</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Gait Disorders, Neurologic - etiology</subject><subject>HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>HISTOLOGY</subject><subject>IRRADIATION</subject><subject>Medical sciences</subject><subject>Myelin Sheath - pathology</subject><subject>Myelin Sheath - radiation effects</subject><subject>NECROSIS</subject><subject>Radiation Dosage</subject><subject>RADIATION DOSE DISTRIBUTIONS</subject><subject>RADIATION DOSES</subject><subject>RADIATION INJURIES</subject><subject>Radiation Injuries, Experimental - complications</subject><subject>Radiation Injuries, Experimental - pathology</subject><subject>Radiation therapy and radiosensitizing agent</subject><subject>Radiation Tolerance</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - adverse effects</subject><subject>Radiosurgery - methods</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Reirradiation</subject><subject>Retreatment</subject><subject>SPINAL CORD</subject><subject>Spinal Cord - pathology</subject><subject>Spinal Cord - radiation effects</subject><subject>Spinal cord tolerance</subject><subject>Stereotactic spinal radiosurgery</subject><subject>SURGERY</subject><subject>SWINE</subject><subject>Swine, Miniature</subject><subject>Time Factors</subject><subject>Treatment with physical agents</subject><subject>Treatment. General aspects</subject><subject>Tumors</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUl1rFDEUDWKx2-o_EBmQPs6Yz52JD0JZrAothW6lvoVMcmc34zRZktnK_vtm3NpqX3wK5J577rn3HITeElwRTOYf-sr1MbSbimJCKtxUmOEXaEaaWpZMiB8v0QyzOS5ZBh-io5R6jDOy5q_QIaVE1pTJGbpZbpzXQ7EI0RbXYYCovYFiDMUVuBi1dXp0wRc3blwXS-dXA5RnUZvfn1e5HNI2riDuPhanxfKX81BcBAvDa3TQ6SHBm4f3GH0_-3y9-FqeX375tjg9L42o52NpKTUSSEcJb7mlgggpKbesaYnmtZYEC4250MK2wmJgrLW8lqIjljPNTM2O0ac972bb3oI14MeoB7WJ7lbHnQraqX8r3q3VKtwpxgjHkmWC93uCkEanknEjmLUJ3oMZFaVYNJLSjOJ7lIkhpQjd4wSC1WSH6tXeDjXZoXCjsh257d3f6h6b_tw_A04eADoZPXTT9V16wgnZUNHQpzUh3_LOQZyUQnbKujgJtcH9T8lzAjM47_LMn7CD1IdtzDFIiqhEFVbLKTpTcgjBLEeqZvfCsr-Q</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Medin, Paul M., Ph.D</creator><creator>Foster, Ryan D., Ph.D</creator><creator>van der Kogel, Albert J., Ph.D</creator><creator>Sayre, James W., Ph.D</creator><creator>McBride, William H., D.Sc</creator><creator>Solberg, Timothy D., Ph.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>OTOTI</scope><scope>5PM</scope></search><sort><creationdate>20120701</creationdate><title>Spinal Cord Tolerance to Reirradiation With Single-Fraction Radiosurgery: A Swine Model</title><author>Medin, Paul M., Ph.D ; Foster, Ryan D., Ph.D ; van der Kogel, Albert J., Ph.D ; Sayre, James W., Ph.D ; McBride, William H., D.Sc ; Solberg, Timothy D., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c576t-d22c9e1f214b4d25159924d38b1a47a9105a045a5db5d0e33bd4795f1d43a3c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Animals</topic><topic>Biological and medical sciences</topic><topic>Cervical Vertebrae</topic><topic>Diseases of the nervous system</topic><topic>Dose-Response Relationship, Radiation</topic><topic>Female</topic><topic>Gait Disorders, Neurologic - etiology</topic><topic>HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>HISTOLOGY</topic><topic>IRRADIATION</topic><topic>Medical sciences</topic><topic>Myelin Sheath - pathology</topic><topic>Myelin Sheath - radiation effects</topic><topic>NECROSIS</topic><topic>Radiation Dosage</topic><topic>RADIATION DOSE DISTRIBUTIONS</topic><topic>RADIATION DOSES</topic><topic>RADIATION INJURIES</topic><topic>Radiation Injuries, Experimental - complications</topic><topic>Radiation Injuries, Experimental - pathology</topic><topic>Radiation therapy and radiosensitizing agent</topic><topic>Radiation Tolerance</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - adverse effects</topic><topic>Radiosurgery - methods</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Reirradiation</topic><topic>Retreatment</topic><topic>SPINAL CORD</topic><topic>Spinal Cord - pathology</topic><topic>Spinal Cord - radiation effects</topic><topic>Spinal cord tolerance</topic><topic>Stereotactic spinal radiosurgery</topic><topic>SURGERY</topic><topic>SWINE</topic><topic>Swine, Miniature</topic><topic>Time Factors</topic><topic>Treatment with physical agents</topic><topic>Treatment. General aspects</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Medin, Paul M., Ph.D</creatorcontrib><creatorcontrib>Foster, Ryan D., Ph.D</creatorcontrib><creatorcontrib>van der Kogel, Albert J., Ph.D</creatorcontrib><creatorcontrib>Sayre, James W., Ph.D</creatorcontrib><creatorcontrib>McBride, William H., D.Sc</creatorcontrib><creatorcontrib>Solberg, Timothy D., Ph.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>OSTI.GOV</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Medin, Paul M., Ph.D</au><au>Foster, Ryan D., Ph.D</au><au>van der Kogel, Albert J., Ph.D</au><au>Sayre, James W., Ph.D</au><au>McBride, William H., D.Sc</au><au>Solberg, Timothy D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spinal Cord Tolerance to Reirradiation With Single-Fraction Radiosurgery: A Swine Model</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>83</volume><issue>3</issue><spage>1031</spage><epage>1037</epage><pages>1031-1037</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>Purpose This study was performed to determine swine spinal cord tolerance to single-fraction, partial-volume irradiation 1 year after receiving uniform irradiation to 30 Gy in 10 fractions. Methods and Materials A 10-cm length of spinal cord (C3–T1) was uniformly irradiated to 30 Gy in 10 consecutive fractions and reirradiated 1 year later with a single radiosurgery dose centered within the previously irradiated segment. Radiosurgery was delivered to a cylindrical volume approximately 5 cm in length and 2 cm in diameter, which was positioned laterally to the cervical spinal cord, resulting in a dose distribution with the 90%, 50%, and 10% isodose lines traversing the ipsilateral, central, and contralateral spinal cord, respectively. Twenty-three pigs were stratified into six dose groups with mean maximum spinal cord doses of 14.9 ± 0.1 Gy ( n = 2), 17.1 ± 0.3 Gy ( n = 3), 19.0 ± 0.1 Gy ( n = 5), 21.2 ± 0.1 Gy ( n = 5), 23.4 ± 0.2 Gy ( n = 5), and 25.4 ± 0.4 Gy ( n = 3). The mean percentage of spinal cord volumes receiving ≥10 Gy for the same groups were 34% ± 1%, 40% ± 1%, 46% ± 3%, 52% ± 1%, 56 ± 3%, and 57% ± 1%. The study endpoint was motor neurologic deficit as determined by a change in gait during a 1- year follow-up period. Results A steep dose-response curve was observed with a 50% incidence of paralysis (ED50 ) for the maximum point dose of 19.7 Gy (95% confidence interval, 17.4–21.4). With two exceptions, histology was unremarkable in animals with normal neurologic status, while all animals with motor deficits showed some degree of demyelination and focal white matter necrosis on the irradiated side, with relative sparing of gray matter. Histologic comparison with a companion study of de novo irradiated animals revealed that retreatment responders had more extensive tissue damage, including infarction of gray matter, only at prescription doses >20 Gy. Conclusion Pigs receiving spinal radiosurgery 1 year after receiving 30 Gy in 10 fractions were not at significantly higher risk of developing motor deficits than pigs that received radiosurgery alone.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22197239</pmid><doi>10.1016/j.ijrobp.2011.08.030</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Animals Biological and medical sciences Cervical Vertebrae Diseases of the nervous system Dose-Response Relationship, Radiation Female Gait Disorders, Neurologic - etiology HAZARDS Hematology, Oncology and Palliative Medicine HISTOLOGY IRRADIATION Medical sciences Myelin Sheath - pathology Myelin Sheath - radiation effects NECROSIS Radiation Dosage RADIATION DOSE DISTRIBUTIONS RADIATION DOSES RADIATION INJURIES Radiation Injuries, Experimental - complications Radiation Injuries, Experimental - pathology Radiation therapy and radiosensitizing agent Radiation Tolerance Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - adverse effects Radiosurgery - methods RADIOTHERAPY Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Reirradiation Retreatment SPINAL CORD Spinal Cord - pathology Spinal Cord - radiation effects Spinal cord tolerance Stereotactic spinal radiosurgery SURGERY SWINE Swine, Miniature Time Factors Treatment with physical agents Treatment. General aspects Tumors |
| title | Spinal Cord Tolerance to Reirradiation With Single-Fraction Radiosurgery: A Swine Model |
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