title: Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer.
abstract: OBJECTIVE
  The goal of this work was to examine toxicity and risk factors after irradiation of the cervical spinal cord.
  
  
  METHODS
  A total of 437 patients irradiated for a laryngeal and oropharyngeal carcinoma were eligible (median follow-up 27 months). Spinal cord contouring was defined differently over time as anatomically defined spinal cord area (SCA) and the spinal cord on CT (SC) with a margin of 3 or 5 mm (SCP3/SCP5).
  
  
  RESULTS
  None developed chronic progressive radiation myelopathy (CPRM) (maximum spinal dose 21.8-69 Gy); 3.9% (17/437) developed a Lhermitte sign (LS) with a median duration of 6 months (range 1-30 months) and was reversible in all patients. Risk factors for developing LS were younger age (52 vs. 61 years, p < 0.001), accelerated RT (12/17 patients, p < 0.005), and dose-volume relationships for SCA with ≥ 45 Gy of 14.15 cm(3) and 7.9 cm(3) for patients with and without LS, respectively.
  
  
  CONCLUSIONS
  LS is more frequently observed in younger patients and in patients treated with accelerated radiotherapy. A dose-volume relationship was seen for V45 in the case of SCA. For higher doses, no clear dose-volume relationships were observed.
authors.affiliation: Dept Radiation-Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
authors.forename: V E M
authors.initials: VE
authors.lastname: Mul
authors.forename: J M A
authors.initials: JM
authors.lastname: de Jong
authors.forename: L H P
authors.initials: LH
authors.lastname: Murrer
authors.forename: P L A
authors.initials: PL
authors.lastname: van den Ende
authors.forename: R M A
authors.initials: RM
authors.lastname: Houben
authors.forename: M
authors.initials: M
authors.lastname: Lacko
authors.forename: P
authors.initials: P
authors.lastname: Lambin
authors.forename: B G
authors.initials: BG
authors.lastname: Baumert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D013116:Spinal Cord / Q000528:radiation effects*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate