title: The use of gold foil wrapping for radiation protection of the spinal cord for recurrent tumor therapy.
abstract: OBJECTIVE
  The development of a technique to provide sufficient radiation protection to previously irradiated spinal cord in such a manner that interstitial brachytherapy can be conducted after resection of a recurrent tumor and decompression of the cord.
  
  
  METHODS
  A technique was developed that uses multiple layers of gold foil that are applied around the thecal sac and nerve root sleeves to produce an enveloping radiation shield after resection of recurrent tumor. Once the layers of gold foil are in place, interstitial I125 seeds are permanently placed in the bed of the tumor resection to prevent any recurrence from microcellular disease. The technique is described and its application in the case of a 28-year-old with a third recurrence of chondrosarcoma after external fractionated radiation therapy at the second to the fourth thoracic segments is reviewed.
  
  
  RESULTS
  This technique has been used in this first patient. An additional tumor dose of 120.0 Gy was delivered to the tumor bed while the spinal cord was calculated to receive only 1% of the dose over the life span of the implant. To date, this dose of radiation has prevented tumor recurrence for more than 18 months of follow-up.
  
  
  CONCLUSIONS
  This technique of multiple layers of gold foil shielding over the spinal cord and nerve roots has the potential to be a useful tool for the shielding of a previously irradiated spinal cord in the setting of resection of recurrent tumor. It may also have a wider application to a number of other radiosensitive tumors where interstitial brachytherapy may be useful to provide additional treatment after external fractionated radiation therapy.
authors.affiliation: Department of Surgery, University of Arizona Health Sciences Center, Tucson 85724, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hamilton
authors.forename: B
authors.initials: B
authors.lastname: Lulu
authors.forename: B
authors.initials: B
authors.lastname: Stea
authors.forename: C W
authors.initials: CW
authors.lastname: Cheng
authors.forename: J R
authors.initials: JR
authors.lastname: Cassady
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000379:methods*; D002813:Chondrosarcoma / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006046:Gold; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007796:Laminectomy; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D018365:Neoplasm, Residual; D011835:Radiation Protection / Q000295:instrumentation*; D011879:Radiotherapy Dosage; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013904:Thoracic Vertebrae
chemical_list: D007457:Iodine Radioisotopes; D006046:Gold