Scylla or Charybdis: Case Report on Radiation Tolerance of the SpinalcordAstrid Dalhaug1, Adam Pawinski1, Terje Tollåli2 and Carsten Nieder1,3*
- 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.