Document Detail


Spinal cord tolerance in the age of spinal radiosurgery: lessons from preclinical studies.
MedLine Citation:
PMID:  21183290     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clinical implementation of spinal radiosurgery has increased rapidly in recent years, but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970s. The influences of field length, dose rate, inhomogeneous dose distributions, and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in preclinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small- and large-animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Preclinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose-volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data are sparse, but results from guinea pig, rat, and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials.
Authors:
Paul M Medin; Thomas P Boike
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2010-12-22
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  79     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-18     Completed Date:  2011-05-12     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1302-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390-9183, USA. Paul.medin@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Animals
Dose-Response Relationship, Radiation
Guinea Pigs
Humans
Mice
Models, Animal
Rabbits
Radiation Injuries, Experimental / pathology
Radiation Tolerance*
Radiosurgery*
Radiotherapy Dosage
Rats
Spinal Cord / pathology,  radiation effects*
Swine
Grant Support
ID/Acronym/Agency:
R01 NS049517/NS/NINDS NIH HHS; R01 NS049517-06/NS/NINDS NIH HHS
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