An Assessment of Spinal Cord Dose Following Radiotherapy of Nasopharyngeal Cancer by TLD and Rando Phantom

Introduction: Nasopharyngeal carcinoma is one of the most common malignancies in the head and neck region and radiotherapy is its treatment of choice. In spite of the fact that it is widely used, due to the presence of many sensitive organs or tissues in this region, patients may suffer from a wide range of side effects. One such sensitive tissue is the spinal cord. If the absorbed dose to spinal cord is greater than its tolerance dose, then myelopathy and Lhermitte’s sign are not avoidable. Material and Methods: Thehead and neck of a Rando phantom (reference man) was employed as a hypothetical patient suffering from nasopharyngeal carcinoma. The full course of treatment consisted of three phases. At the beginning of every phase, an oncologist used a simulator to delineate the surface of the Rando Phantom for treatment. TLD chips (TLD-100) were employed for dose measurement. TLD chips were inserted in the previously made holes on the surface of selected slices adjacent to second cervical to fourth thoracic vertebra. Absorbed dose by TLDs were read by a Harshaw 3500 TLD reader. Results: Total measured dose (in Gy) of various parts of spinal cord adjacent to second cervical to fourth thoracic vertebra varied widely and were as follows respectively: 15.24±1.31, 50.31±1.06, 49.15±2.77, 47.48±1.42, 54.56±2.6, 48.92±0.6, 45.1±0.45. In other words, the range of doses received by different segments of the spinal cord could be as wide as 15.24 to 54.56 Gy. Conclusion: Although the spinal cord was excluded at the end of the first phase, a significant change in the absorbed dose at the end of the first and second phases was not observed. In phase three, the anterior neck field was replaced by a lateral field and the spinal cord absorbed dose was reduced considerably. According to our results, absorbed doses of the spinal cord segments corresponding to the region confined between the third cervical to third thoracic vertebra were more than the 47 Gy recommended tolerance dose value. Therefore, special attention must be paid to protect this sensitive tissue while the treatment is performed. Application of modern techniques such as IMRT, if available, will reduce the unnecessary dose the spinal cord and its consequent biological risks considerably.