Variation in radiation sensitivity and repair kinetics in different parts of the spinal cord

Abstract

Background. The spinal cord, known for its strongly serial character and high sensitivity to radiation even when a small segment is irradiated, is one of the most critical organs at risk to be spared during radiation therapy. To compare the sensitivity of different parts of the spinal cord, data for radiation myelopathy have been used. Material and methods. In the present study, the relative seriality model was fitted to two different datasets of clinical radiation myelitis concerning cervical spinal cord after treating 248 patients for head and neck cancer and thoracic spinal cord after treating 43 patients with lung carcinoma. The maximum likelihood method was applied to fit the clinical data. The model parameters and their 68% confidence intervals were calculated for each dataset. The α/β ratio for the thoracic cord was also was also found to be 0.9 (0–3.0) Gy. Results. The dose-response curve for the more sensitive cervical myelopathy is well described by the parameters D₅₀=55.9 (54.8–57.1) Gy, γ=6.9 (5.0–9.2), s=0.13 (0.07–0.24), whereas the thoracic myelopathy is described by the parameters D₅₀=75.5 (70.5–80.8) Gy, γ=1.1 (0.6–1.6), s=36 (3.3−∞). Discussion and conclusions. Large differences in radiation response between the cervical and thoracic region of spinal cord are thus observed: cervical myelopathy seems to be characterized by medium seriality, while thoracic spinal cord is characterized by a highly serial dose-response. The much steeper dose-response curve for cervical spinal cord myelopathy can be interpreted as a higher number of functional subunits consistent with a higher amount of white matter close to the brain.