'Full dose' reirradiation of human cervical spinal cord

With the progress of modern multimodality cancer treatment, retreatment of late recurrences or second tumors became more commonly encountered in manag ement of patients with cancer. Spinal cord retreatment with radiation is a common problem in this regard, Because radiation myelopathy may result in f unctional deficits, many oncologists are concerned about radiation-induced myelopathy when retreating tumors located within or immediately adjacent to the previous radiation portal. The treatment decision is complicated becau se it requires a pertinent assessment of prognostic factors with and withou t reirradiation, radiobiologic estimation of recovery of occult spinal cord damage from the previous treatment, as well as interactions because of mul timodality treatment. Recent studies regarding reirradiation of spinal cord in animals using limb paralysis as an endpoint have shown substantial and almost complete recovery of spinal cord injury after a sufficient time afte r the initial radiotherapy. We report a case of "full" dose reirradiation o f the entire cervical spinal cord in a patient who has not developed clinic ally detectable radiation-induced myelopathy on long-term follow-up of 17 y ears after the first radiotherapy and 5 years after the second radiotherapy .