Spinal Cord Compression

Question 1

What is an option for setting your depth on a spinal cord compression field without using the SSD provided by the ODI?

Answer 1

Use the shifts from the patient’s tattoos to determine the treatment table’s vertical position for proper treatment.

Other methods include measuring the patient’s separation and marking the lateral skin or adjusting the table based on laser alignment.

Question 2

True or False: Patient side effects would be worse if you treated a spinal cord compression with parallel opposed fields in the AP/PA positions.

Answer 2

True

The PA position results in anterior organs receiving an exit dose after the maximum dose has been calculated for the spinal cord tumor.

Question 3

True or False: You can perform a traditional clinical spinal cord compression set-up without any imaging.

Answer 3

False

Without imaging, you cannot confirm the tumor’s position, making it risky to treat the patient supine.

Question 4

What is the greatest risk to the patient when treating a spinal cord compression?

Answer 4

Severing the spinal cord when positioning the patient

Care must be taken to avoid breaking the patient’s spine at the tumor site.

Question 5

True or False: With spinal cord compressions, the doctor isn’t worried about long-term side effects.

Answer 5

True

The focus is usually on palliation of pain and preserving immediate functioning due to the likelihood of metastasis.

Question 6

True or False: The lateral field width when treating a spinal cord compression should not exceed 6 cm.

Answer 6

False

The lateral field width is typically 7 to 8 cm, adjusted based on the tumor’s lateral extent.

Question 7

What is the most common presenting symptom of a spinal cord compression?

Answer 7

Pain

Pain is the primary symptom that leads patients to seek medical attention.

Question 8

What is the most commonly ignored presenting symptom of a spinal cord compression?

Answer 8

Pain

Patients often attribute the pain to other causes, delaying treatment until more severe symptoms arise.

Question 9

Which of the following is not a common primary tumor that can cause a spinal cord compression?
1. Lung carcinoma
2. Lymphoma
3. Soft tissue sarcoma
4. Prostate carcinoma

Answer 9

Soft tissue sarcoma

Common causes include lung, prostate, and breast carcinomas, as well as lymphomas.

Question 10

True or False: In some spinal cord compressions, you can palpate the patient to determine the field size.

Answer 10

True

Tumors that are palpable or visible can help in determining field position and size.

Question 11

Why is spinal cord compression considered a medical emergency?

Answer 11

Spinal cord compression is an emergency because it can lead to permanent neurological damage if left untreated. Severing of the spinal cord due to a tumor or vertebral collapse can result in paralysis.

Immediate intervention is crucial to prevent irreversible harm.

Question 12

What is the most frequent cause of spinal cord compression?

Answer 12

The most common cause of spinal cord compression is metastasis to the spine from primary tumors elsewhere in the body, such as lung, prostate, or breast cancer.

These tumors often extend into the epidural space, compressing the spinal cord.

Question 13

Name four of the most common presenting symptoms of spinal cord compression.

Answer 13

Four common presenting symptoms are:
* Pain
* Weakness
* Autonomic dysfunction (loss of bowel and bladder control)
* Sensory loss

The specific symptoms and their severity depend on the location and extent of the compression.

Question 14

How is a diagnosis of spinal cord compression typically achieved?

Answer 14

Diagnosis is typically achieved through a careful neurological exam, followed by imaging studies such as CT scans and MRI.

These imaging techniques help visualize the spinal cord and identify any compression.

Question 15

What type of medication is often administered in the initial treatment of spinal cord compression?

Answer 15

Corticosteroids, such as Dexamethasone, are often administered to reduce inflammation and swelling around the spinal cord.

This can help alleviate pressure and improve neurological function in the short term.

Question 16

Under what circumstances might chemotherapy be used in the treatment of spinal cord compression?

Answer 16

Chemotherapy may be used if the cancer causing the spinal cord compression is highly chemo-sensitive, such as lymphoma or small cell carcinoma of the lung.

It can be administered before, during, or after radiation therapy.

Question 17

Describe two scenarios in which surgery might be considered for a patient with spinal cord compression.

Answer 17

Surgery might be performed when:
* The cause of compression is not histologically diagnosed as cancer
* There is a collapsed vertebra on an X-ray

Surgery is typically a laminectomy, to remove the vertebra.

Question 18

What is the typical patient position for radiation therapy to treat spinal cord compression?

Answer 18

The typical patient position for radiation therapy is prone, which allows for optimal access to the posterior spine.

Supine positioning is another option to consider with a manual set-up.

Question 19

When using traditional radiation beam configuration, what is a possible field arrangement?

Answer 19

When treating using traditional radiation therapy setup, a single PA (posterior-anterior) field is one option for spinal cord compression.

Using a CT-planned alternative is another option.

Question 20

What is a common radiation dosing range (in Gy) for spinal cord compression, and what are some common fractionation schemes?

Answer 20

The total dose range is typically 30 to 40 Gy in 2 to 4 weeks. Common fractionation schemes include:
* 20 Gy in 5 fractions at 4 Gy per fraction
* 30 Gy in 10 fractions at 3 Gy per fraction
* 30-36 Gy in 15-18 fractions at 1.8 Gy per fraction (especially for lymphoma)

These schemes are tailored to the patient’s specific condition.

Question 21

What is the Epidural Space?

Answer 21

The space between the dura mater and the vertebral column, where tumors can extend and compress the spinal cord.

The epidural space is crucial in understanding spinal cord compression and related pathologies.

Question 22

Define Autonomic Dysfunction.

Answer 22

Disruption of the autonomic nervous system, leading to loss of bowel and bladder control.

Autonomic dysfunction can significantly impact quality of life and may require specialized management.

Question 23

What are Corticosteroids (Dexamethasone) used for?

Answer 23

Medications used to reduce inflammation and swelling, often used in the initial treatment of spinal cord compression.

Dexamethasone is a common choice in managing spinal conditions due to its anti-inflammatory properties.

Question 24

What is a Laminectomy?

Answer 24

A surgical procedure that involves removing a portion of the vertebral bone (lamina) to relieve pressure on the spinal cord.

Laminectomy is often performed to alleviate symptoms caused by spinal stenosis or tumors.

Question 25

What are Posterior Oblique Fields (LPO & RPO)?

Answer 25

Radiation fields angled from the posterior of the patient in an oblique direction. ## Footnote These fields are used in CT planned alternative beam arrangements for targeted radiation therapy.

Question 26

What is a Solitary Plasmacytoma?

Answer 26

A rare type of plasma cell tumor that occurs in bone or soft tissue and can cause spinal cord compression. ## Footnote Solitary plasmacytoma can progress to multiple myeloma if not treated appropriately.

Question 27

What are the typical superior and inferior borders for a spinal cord compression, according to "Portal Design in Radiation Therapy"?

Answer 27

3 to 4 cm beyond the cord compression Page 209: 3 to 4 cm beyond the cord compression, or 2 vertebral bodies beyond the spinal cord compression.

Question 28

What is the typical field width, depending on the extent of the tumor, for a spinal cord compression, according to "Portal Design in Radiation Therapy"?

Answer 28

7 to 8 cm lateral field width is recommended

Question 29

What is the standard, clinical or manual setup and treatment (not using a CT and computer planning) for treating a spinal cord compression? (Hint: How would you treat without imaging)

Answer 29

Patient prone with a single PA radiation field According to " Practical Radiotherapy Planning" all of these are possible field and setup configurations using modern technology, pages 65 to 66. But, the question is asking you to use only your own resources, not that of a computer.

Question 30

What is a significant concern when treating a spinal cord compression in the prone position?

Answer 30

Laying in the prone position puts additional strain on the spinal column and could cause a break that severs the cord. Manual wedges could be used for significant slopes of the back. Patients are often in more pain when lying supine on the spine. Breathing is not usually significantly affected by position, but the normal breathing process may cause spine pain in any position. However, you are always worried about breaking the spinal column and cord, especially in the prone position.

Question 31

Question 32

According to "Portal Design in Radiation Therapy" patients with spinal cord compressions typically receive "a total dose range from _________ Gy in two to four weeks."

Answer 32

30 to 40

Question 33

According to "Portal Design in Radiation Therapy," with regards to a spinal cord compression, "the initial fractionation schedule should be higher." What is the dose per fraction for treating a spinal cord compression in those initial fractions? (Hint: Do not think average or maximum)

Answer 33

3.5 to 4.0 Gy per fraction