Int J Radiat Oncol Biol Phys 2019 Oct 10
Spinal Cord Dose Tolerance to Stereotactic Body Radiation Therapy.
Related Questions
Would you consider spine re-irradiation after Pluvicto?
This question will become more common as more patients undergo PSMA-based radiopharmaceutical therapy (RPT). The focus of this question seems to be related to the additional dose to which RPT may expose the cord and the ensuing risk of myelopathy. In summary, I do not believe there is (or could be) ...
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...
What dose constraint do you use for the spinal cord and/or cauda equina for a spinal meningioma?
Presumably WHO 1. 50.4/28 fractions. Good control. Low risk of injury.
Can you give Pluvicto with concurrent palliative EBRT?
Short answer: Yes, you can, and I do not modify my dose. I have no issues with this and have done it multiple times for patients who need more immediate symptom relief (pain, bleeding, etc.).Why? Because Pluvicto is a medium energy isotope with a relatively short path length of around 2 mm. Even nea...
How do you balance target coverage vs cord constraints with spine SRS?
In general, balancing competing target coverage and OAR exposure considerations is always a risk/benefit proposition. Having a marginal failure where you sacrificed coverage to meet a constraint associated with a <5% complication rate is always cause for regret. If a cord constraint cannot be met wi...
What do you consider to be the minimum technological requirements to safely deliver spine SBRT?
In the spirit of careful attention to detail, there are a number of ways to answer this question. I will draw from our early institutional experience to prove some guidance on minimal technologic requirements for safe spine SBRT. The key elements are 1. Accurate imaging for target and organs at risk...