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The maximum dose (Dmax) and dose to 0.1cc (D0.1cc) were determined (magnetic resonance imaging [MRI]-defined cord) and expressed as equivalent dose in 2\u2011Gy fractions (EQD2) with an \u03b1\/\u03b2\u00a0value of 2\u202fGy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All 32\u00a0patients remained free from radiation myelopathy after a\u00a0median follow-up of 12\u00a0months. Re-irradiation was performed after 6\u201397\u00a0months (median\u00a015). In 22\u00a0cases (69%) the re-irradiation spinal cord EQD2 Dmax was higher than that of the first treatment course. Forty-eight of 64\u00a0treatment courses employed fraction sizes of 2.5 to 4\u202fGy to the target volume. The median cumulative spinal cord EQD2 Dmax was 80.7\u202fGy, minimum 61.12\u202fGy, maximum 114.79\u202fGy. The median cumulative spinal cord D0.1cc EQD2 was 76.1\u202fGy, minimum 61.12\u202fGy, maximum 95.62\u202fGy. Besides cumulative dose, other risk factors for myelopathy were present (single-course Dmax EQD2 \u226551\u202fGy in 9\u00a0patients, single-course D0.1cc EQD2 \u226551\u202fGy in 5\u00a0patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even patients treated to higher cumulative doses than previously recommended, or at a\u00a0considerable risk of myelopathy according to a\u00a0published risk score, remained free from this complication, although one must acknowledge the potential for manifestation of damage in patients currently alive, i.e., still at risk. Individualized decisions to re-irradiate after appropriate informed consent are an acceptable strategy, including scenarios where low re-irradiation doses to the spinal cord would compromise target coverage and tumor control probability to an unacceptable degree.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-021-01772-7","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T09:03:06Z","timestamp":1620205386000},"page":"463-473","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["New clinical data on human spinal cord re-irradiation tolerance"],"prefix":"10.1007","volume":"197","author":[{"given":"Hiroshi","family":"Doi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Tamari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoong-Jin","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1592-2908","authenticated-orcid":false,"given":"Carsten","family":"Nieder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"key":"1772_CR1","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1016\/j.ijrobp.2011.08.030","volume":"83","author":"PM Medin","year":"2012","unstructured":"Medin\u00a0PM, Foster\u00a0RD, van der Kogel\u00a0AJ et al (2012) Spinal cord tolerance to reirradiation with single-fraction radiosurgery: a\u00a0swine model. 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