alexa Scylla or Charybdis: Case Report on Radiation Tolerance
ISSN: 2155-9619

Journal of Nuclear Medicine & Radiation Therapy
Open Access

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Case Report

Scylla or Charybdis: Case Report on Radiation Tolerance of the Spinalcord

Astrid Dalhaug1, Adam Pawinski1, Terje Tollåli2 and Carsten Nieder1,3*

1Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway

2Department of Internal Medicine, Nordland Hospital, Bodø, Norway

3Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway

Corresponding Author:
Carsten Nieder
Department of Oncology and Palliative Medicine
Nordland Hospital, 8092 Bodø, Norway
Tel: +47 75 57 8449
Fax: +47 75 53 4975
E-mail: [email protected]

Received Date: April 05, 2011; Accepted Date: July 15, 2011; Published Date: July 20, 2011

Citation: Dalhaug A, Pawinski A, Tollåli T, Nieder C (2011) Scylla or Charybdis: Case Report on Radiation Tolerance of the Spinalcord. J Nucl Med Radiat Ther 2:114. doi:10.4172/2155-9619.1000114

Copyright: © 2011 Dalhaug A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



A case of rapid cancer progression causing impending spinal cord compression at the margin of a previously irradiated treatment volume close to the thoracic spinal cord in a patient with non-small cell lung cancer is presented. The patient and treating physicians were faced with a difficult decision. Either reirradiate and accept a considerable risk of delayed radiation myelopathy or risk paraplegia as a result of tumour progression. To prevent rapid development of neurological deficits, the patient was reirradiated only 34 days after he had finished his initial course of simultaneous radio- and chemotherapy. The high cumulative spinal cord dose (corresponding to 84 Gy in 2-Gy fractions) and short interval to reirradiation resulted in a high risk of radiation myelopathy according to a previously published risk score. However, no treatment-related toxicity developed and neurological function was preserved for almost 5 months. Eventually, tumour progression resulted in paraplegia. This case illustrates important issues around palliative reirradiation of target volumes close to the spinal cord.


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