PURPOSE: We have observed a higher rate of Lhermitte sign (LS) after chemo-intensity-modulated radiotherapy (IMRT) of head-and-neck cancer than the published rates after conventional radiotherapy. We hypothesized that the inhomogeneous spinal cord dose distributions produced by IMRT caused a "bath-and-shower" effect, characterized by low doses in the vicinity of high doses, reducing spinal cord tolerance. METHODS AND MATERIALS: Seventy-three patients with squamous cell carcinoma of the oropharynx participated in a prospective study of IMRT concurrent with weekly carboplatin and paclitaxel. Of these, 15 (21%) reported LS during at least 2 consecutive follow-up visits. Mean dose, maximum dose, and partial volume and absolute volume (in milliliters) of spinal cord receiving specified doses (≥10 Gy, ≥20 Gy, ≥30 Gy, and ≥40 Gy), as well as the pattern of dose distributions at the "anatomic" spinal cord (from the base of the skull to the aortic arch) and "plan-related" spinal cord (from the top through the bottom of the planning target volumes), were compared between LS patients and 34 non-LS patients. RESULTS: LS patients had significantly higher spinal cord mean doses, V(30), V(40), and absolute volumes receiving 30 Gy or more and 40 Gy or more compared with the non-LS patients (p < 0.05). The strongest predictors of LS were higher V(40) and higher cord volumes receiving 40 Gy or more (p ≤ 0.007). There was no evidence of larger spinal cord volumes receiving low doses in the vicinity of higher doses (bath-and-shower effect) in LS compared with non-LS patients. CONCLUSIONS: Greater mean dose, V(30), V(40), and cord volumes receiving 30 Gy or more and 40 Gy or more characterized LS compared with non-LS patients. Bath-and-shower effects could not be validated in this study as a potential contributor to LS. The higher-than-expected rates of LS may be because of the specific concurrent chemotherapy agents or more accurate identification of LS in the setting of a prospective study.
PURPOSE: We have observed a higher rate of Lhermitte sign (LS) after chemo-intensity-modulated radiotherapy (IMRT) of head-and-neck cancer than the published rates after conventional radiotherapy. We hypothesized that the inhomogeneous spinal cord dose distributions produced by IMRT caused a "bath-and-shower" effect, characterized by low doses in the vicinity of high doses, reducing spinal cord tolerance. METHODS AND MATERIALS: Seventy-three patients with squamous cell carcinoma of the oropharynx participated in a prospective study of IMRT concurrent with weekly carboplatin and paclitaxel. Of these, 15 (21%) reported LS during at least 2 consecutive follow-up visits. Mean dose, maximum dose, and partial volume and absolute volume (in milliliters) of spinal cord receiving specified doses (≥10 Gy, ≥20 Gy, ≥30 Gy, and ≥40 Gy), as well as the pattern of dose distributions at the "anatomic" spinal cord (from the base of the skull to the aortic arch) and "plan-related" spinal cord (from the top through the bottom of the planning target volumes), were compared between LSpatients and 34 non-LSpatients. RESULTS:LSpatients had significantly higher spinal cord mean doses, V(30), V(40), and absolute volumes receiving 30 Gy or more and 40 Gy or more compared with the non-LSpatients (p < 0.05). The strongest predictors of LS were higher V(40) and higher cord volumes receiving 40 Gy or more (p ≤ 0.007). There was no evidence of larger spinal cord volumes receiving low doses in the vicinity of higher doses (bath-and-shower effect) in LS compared with non-LSpatients. CONCLUSIONS: Greater mean dose, V(30), V(40), and cord volumes receiving 30 Gy or more and 40 Gy or more characterized LS compared with non-LSpatients. Bath-and-shower effects could not be validated in this study as a potential contributor to LS. The higher-than-expected rates of LS may be because of the specific concurrent chemotherapy agents or more accurate identification of LS in the setting of a prospective study.
Authors: Hendrik P Bijl; Peter van Luijk; Rob P Coppes; Jacobus M Schippers; Antonius W T Konings; Albert J van der Kogel Journal: Int J Radiat Oncol Biol Phys Date: 2003-09-01 Impact factor: 7.038
Authors: Carrie M Carr; John C Benson; David R DeLone; Felix E Diehn; Dong K Kim; Daniel Ma; Alex A Nagelschneider; Ajay A Madhavan; Derek R Johnson Journal: Neuroradiol J Date: 2022-05-01
Authors: M N Duma; T Schuster; N Aswathanarayana; L-S Fromm; M Molls; H Geinitz; S Kampfer Journal: Strahlenther Onkol Date: 2013-10-10 Impact factor: 3.621
Authors: P L Yeap; D J Noble; K Harrison; A M Bates; N G Burnet; R Jena; M Romanchikova; M P F Sutcliffe; S J Thomas; G C Barnett; R J Benson; S J Jefferies; M A Parker Journal: Phys Med Biol Date: 2017-07-12 Impact factor: 3.609
Authors: Bassem Youssef; JoAnn Shank; Jay P Reddy; Chelsea C Pinnix; George Farha; Mani Akhtari; Pamela K Allen; Michelle A Fanale; John A Garcia; Patricia H Horace; Sarah Milgrom; Grace Li Smith; Yago Nieto; Isadora Arzu; He Wang; Nathan Fowler; Maria Alma Rodriguez; Bouthaina Dabaja Journal: Radiat Oncol Date: 2015-09-25 Impact factor: 3.481
Authors: Huaising C Ko; Allison R Powers; Ren-dih Sheu; Sarah L Kerns; Barry S Rosenstein; Stephen C Krieger; Waleed F Mourad; Kenneth S Hu; Vishal Gupta; Richard L Bakst Journal: PLoS One Date: 2015-10-08 Impact factor: 3.240
Authors: Gabriela Studer; Claudia Linsenmeier; Oliver Riesterer; Yousef Najafi; Michelle Brown; Bita Yousefi; Marius Bredell; Gerhard Huber; Stephan Schmid; Stephan Studer; Roger Zwahlen; Tamara Rordorf; Christoph Glanzmann Journal: Radiat Oncol Date: 2013-11-05 Impact factor: 3.481
Authors: Alan Kiang; Vivian K Weinberg; Ka Ho Nicholas Cheung; Erin Shugard; Josephine Chen; Jeanne M Quivey; Sue S Yom Journal: Radiat Oncol Date: 2016-09-26 Impact factor: 3.481
Authors: Hannah M Laidley; David J Noble; Gill C Barnett; Julia R Forman; Amy M Bates; Richard J Benson; Sarah J Jefferies; Rajesh Jena; Neil G Burnet Journal: Radiat Oncol Date: 2018-05-04 Impact factor: 3.481