Cord and Cauda re-treatment

[BraggPeak]

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What dose and dose constaints to people use for spine retreatment?

I hate re-treating spine....

 

[Gfunk6]

What dose and dose constaints to people use for spine retreatment?

I hate re-treating spine....

Need more info on the patient in question before we can answer

 

[BraggPeak]

Need more info on the patient in question before we can answer

65 to with metastatic renal ca, history of metastatic disease to l3 with epidural extension. She s/p decompression and fusion, followed by rt from l2-l5 to dose of 35 gy on 14 fraction (treated at outside facility).

Now 2 years later has large lytic lesion in L2 vertebral body. What sbrt dose would you give (9x3, 6x5, etc) and what constraint for cauda?

 

[Gfunk6]

Would consider SBRT in per RTOG 0631. Cauda equina constraints are kind of made up - unlike for spinal cord/brainstem. Honestly, given the patient's prognosis and progressive disease cauda constraint is probably not terribly relevant. If you are going to go down this route, MRI spine is mandatory to identify precisely where conus ends.

 

[BraggPeak]

Would consider SBRT in per RTOG 0631. Cauda equina constraints are kind of made up - unlike for spinal cord/brainstem. Honestly, given the patient's prognosis and progressive disease cauda constraint is probably not terribly relevant. If you are going to go down this route, MRI spine is mandatory to identify precisely where conus ends.

0631 is the single fraction spine mets study, right?

I was thinking 3 or 5 fractions, like 9x3, but was trying to find a good dose constraint for cauda. What do other people use in this setting?

 

[Areion]

If your patient had palliative RT > 5 months ago, 6 Gy x 5 appears to be reasonable for vertebral body SBRT…

Here’s a nice paper detailing characteristics of patients who did and didn’t get myelitis….It's amazing how much the BED equation is being adapted these days.

http://www.sciencedirect.com/science/article/pii/S0360301610030671