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Lhermitte's Sign Developing after IMRT for Head and Neck Cancer.

Lim DC, Gagnon PJ, Meranvil S, Kaurin D, Lipp L, Holland JM - Int J Otolaryngol (2010)

Bottom Line: Results.Conclusions.We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Oregon Health & Science University, Mailcode KPV4, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.

ABSTRACT
Background. Lhermitte's sign (LS) is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT) for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

No MeSH data available.


Related in: MedlinePlus

Radiation dose distribution as represented by radiation isodose lines displayed in the (a) axial, (b) sagittal, and (c) coronal planes.  The thick purple line represents the 4500 cGy isodose line.  The dose volume histogram (d) graphs the percent volume of structure or target receiving a radiation dose.  Radiation targets including the red gross tumor volume (GTV), the beige expansion of GTV (CTV1), the yellow high-risk clinical volume (CTV2), and light blue low-risk clinical volume (CTV3) are included with the critical normal structures of spinal cord and brainstem.
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fig1: Radiation dose distribution as represented by radiation isodose lines displayed in the (a) axial, (b) sagittal, and (c) coronal planes. The thick purple line represents the 4500 cGy isodose line. The dose volume histogram (d) graphs the percent volume of structure or target receiving a radiation dose. Radiation targets including the red gross tumor volume (GTV), the beige expansion of GTV (CTV1), the yellow high-risk clinical volume (CTV2), and light blue low-risk clinical volume (CTV3) are included with the critical normal structures of spinal cord and brainstem.

Mentions: Our patient is a 55-year-old gentleman with a clinical stage T2N2A moderate to poorly differentiated squamous cell carcinoma of the left tonsil. He received concurrent chemotherapy delivered during the first and fourth weeks of radiation treatment. The chemotherapy consisted of cisplatin at 100 mg/m2 and fluorouracil (5FU) at 1000 mg/m2 on days one through four. We used intensity-modulated radiotherapy with primary intent to spare the right parotid gland. A total dose of 7000 cGy was delivered to our expanded tumor target using 6 MV photons over 35 fractions of 200 cGy each. In treatment planning, the spinal cord was contoured. The maximum spinal cord point dose was 4478 cGy and the mean spinal cord dose was 2692 cGy. Figure 1 displays radiation dose distribution through isodose lines in the axial, sagittal, and coronal planes as well as the dose volume histogram (DVH) for treatment targets, the brainstem and the spinal cord. Image guidance with orthogonal pair radiographs, AP and lateral, was performed prior to each daily treatment. The patient tolerated the treatment course fairly well with expected confluent mucositis and temporary need of a feeding tube for nutrition. The patient lost 3.4 kg (4.9% of initial body weight) throughout the treatment, going from 69.2 kg to 65.9 kg at the completion of treatment on May 19, 2006; the patient showed no evidence of disease.


Lhermitte's Sign Developing after IMRT for Head and Neck Cancer.

Lim DC, Gagnon PJ, Meranvil S, Kaurin D, Lipp L, Holland JM - Int J Otolaryngol (2010)

Radiation dose distribution as represented by radiation isodose lines displayed in the (a) axial, (b) sagittal, and (c) coronal planes.  The thick purple line represents the 4500 cGy isodose line.  The dose volume histogram (d) graphs the percent volume of structure or target receiving a radiation dose.  Radiation targets including the red gross tumor volume (GTV), the beige expansion of GTV (CTV1), the yellow high-risk clinical volume (CTV2), and light blue low-risk clinical volume (CTV3) are included with the critical normal structures of spinal cord and brainstem.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2902147&req=5

fig1: Radiation dose distribution as represented by radiation isodose lines displayed in the (a) axial, (b) sagittal, and (c) coronal planes. The thick purple line represents the 4500 cGy isodose line. The dose volume histogram (d) graphs the percent volume of structure or target receiving a radiation dose. Radiation targets including the red gross tumor volume (GTV), the beige expansion of GTV (CTV1), the yellow high-risk clinical volume (CTV2), and light blue low-risk clinical volume (CTV3) are included with the critical normal structures of spinal cord and brainstem.
Mentions: Our patient is a 55-year-old gentleman with a clinical stage T2N2A moderate to poorly differentiated squamous cell carcinoma of the left tonsil. He received concurrent chemotherapy delivered during the first and fourth weeks of radiation treatment. The chemotherapy consisted of cisplatin at 100 mg/m2 and fluorouracil (5FU) at 1000 mg/m2 on days one through four. We used intensity-modulated radiotherapy with primary intent to spare the right parotid gland. A total dose of 7000 cGy was delivered to our expanded tumor target using 6 MV photons over 35 fractions of 200 cGy each. In treatment planning, the spinal cord was contoured. The maximum spinal cord point dose was 4478 cGy and the mean spinal cord dose was 2692 cGy. Figure 1 displays radiation dose distribution through isodose lines in the axial, sagittal, and coronal planes as well as the dose volume histogram (DVH) for treatment targets, the brainstem and the spinal cord. Image guidance with orthogonal pair radiographs, AP and lateral, was performed prior to each daily treatment. The patient tolerated the treatment course fairly well with expected confluent mucositis and temporary need of a feeding tube for nutrition. The patient lost 3.4 kg (4.9% of initial body weight) throughout the treatment, going from 69.2 kg to 65.9 kg at the completion of treatment on May 19, 2006; the patient showed no evidence of disease.

Bottom Line: Results.Conclusions.We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Oregon Health & Science University, Mailcode KPV4, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.

ABSTRACT
Background. Lhermitte's sign (LS) is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT) for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

No MeSH data available.


Related in: MedlinePlus