Guidelines for Complications of Cancer Treatment Vol VIII Part B

and summarized into specific recommendations for the spinalcord and brain. The common spinal cord dose limit of 45 Gyin 22 to 25 fractions is conservative and can be relaxed ifrespecting this limit materially reduces the probability of tumorcontrol. It is suggested that the 5% incidence of radiationmyelopathy probably lies between 57 and 61 Gy to the spinalcord in the absence of dose modifying chemotherapy. Aclinically detectable length effect for the spinal cord has notbeen observed. The effects of chemotherapy and alteredfractionation are also discussed. Brain necrosis in adults israrely noted below 60 Gy in conventional fractionation, withimaging and clinical changes being observed generally onlyabove 50 Gy. However, neurocognitive effects are observedat lower doses, especially in children. A more pronouncedvolume effect is believed to exist in the brain than in the spinalcord. Tumor progression may be hard to distinguish fromradiation and chemotherapy effects. Diffuse white matter injurycan be attributed to radiation and associated with neurologicaldeficits, but leukoencephalopathy is rarely observed in theabsence of chemotherapy. Subjective, objective, management,and analytic (SOMA) parameters related to radiation spinalcord and brain injury have been developed and presented onordinal scale.Radiation tolerance of the spinal cord: doctrine,dogmas, dataArchive of Oncology. 2000,8 (3):131-4.Lilia Gocheva, Institute of Oncology SremskaKamenica, YugoslaviaRadiation damage to the spinal cord is one of the most fearedcomplications in the treatment of cancer with radiation therapy.There is no uniformly accepted definition of the term‘tolerance’ and this fact reflects differences in the clinical341