What radiation dose constraints should be used for the spinal cord in pediatrics?

Should they be context/disease specific? Should the use of chemotherapy before/after, or during radiotherapy modify these tolerances? Contexts: extramedullary vs. intradural extramedullary vs. intramedullary tumors Diseases: low vs. high grade primary solid tumor/sarcoma or low vs. high grade primary CNS tumors Chemotherapy: are there agents which are considered high risk for myelopathy when combined with radiotherapy?

2 Answers

Mednet MemberInvited Expert

Radiation Oncology · NYU Langone Medical Center

Answered on

As part of the PENTEC project (Constine et al., PMID 37999712), I had the privilege of finding all of the cases of pediatric radiation myelitis in the literature. This is modified from our published findings, I encourage you to read the full manuscript if you would like further details (Cooper et al., PMID 38323945).

The most recent Children's Oncology Group trial for patients with localized Ewing sarcoma (AEWS 1031) allowed a maximum dose of 50.4 Gy to the spinal cord and did not report any cases of radiation myelopathy. Cooper et al., PMID 38323945
In these paraspinal Ewing sarcoma cases, the cord is usually treated at or near that tolerance to adequately cover disease. Additionally, the most recently published Children's Oncology Group e...

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Mednet MemberInvited Expert

Radiation Oncology · University of Toronto

Answered on

I have been going to 50.4-52.2 Gy for large volumes and 54 Gy for small volumes (1.8 Gy per day).

I would be more careful with radiosensitizing chemotherapy – busulfan, cisplatin, etc.

I have not been modifying doses based on histology or location (intramedullary vs extramedullary).

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