Spinal Cord Dose Tolerance to Stereotactic Body Radiation Therapy

Arjun Sahgal, Joe H. Chang, Lijun Ma, Lawrence B. Marks, Michael T. Milano, Paul Medin, Andrzej Niemierko, Scott G. Soltys, Wolfgang A. Tomé, C. Shun Wong, Ellen Yorke, Jimm Grimm, Andrew Jackson

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


Spinal cord tolerance data for stereotactic body radiation therapy (SBRT) were extracted from published reports, reviewed, and modelled. For de novo SBRT delivered in 1 to 5 fractions, the following spinal cord point maximum doses (Dmax) are estimated to be associated with a 1% to 5% risk of radiation myelopathy (RM): 12.4 to 14.0 Gy in 1 fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. For reirradiation SBRT delivered in 1 to 5 fractions, reported factors associated with a lower risk of RM include cumulative thecal sac equivalent dose in 2 Gy fractions with an alpha/beta of 2 (EQD22) Dmax ≤70 Gy; SBRT thecal sac EQD22 Dmax ≤25 Gy, thecal sac SBRT EQD22 Dmax to cumulative EQD22 Dmax ratio ≤0.5, and a minimum time interval to reirradiation of ≥5 months. Larger studies containing complete institutional cohorts with dosimetric data of patients treated with spine SBRT, with and without RM, are required to refine RM risk estimates.

Original languageEnglish (US)
Pages (from-to)124-136
Number of pages13
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number1
StatePublished - May 1 2021

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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