Kyphoplasty and intra-operative radiotheray, combination of kyphoplasty and intra-operative radiation for spinal metastases: technical feasibility of a novel approach

Abstract

Purpose To evaluate whether this new method is clinically applicable after theoretical and cadaver testing. Methods The incidence of spinal metastases requiring therapy is increasing, due to enhanced life expectancy. Due to results from studies with epidural compression a combined surgical and radiation therapy is often chosen. Minimal invasive cement augmentation is an increasingly used technique, due to fast pain relief and immediate stabilisation. On the other hand, stereotactic radiosurgery is considered to provide a more durable response and better local disease control than conventional radiotherapy with the application of higher doses. Therefore the combination of cement stabilisation and simultaneous intra-operative radiation with immediate stabilisation and high-dose radiation could be an interesting therapeutic option. The results of a clinical feasibility study are presented.Results 17 patients could be treated with the new method. In two patients (10%) intra-operative radiation could not be applied. No surgical interventions for complications were required. Conclusions Summarizing Kypho-IORT is technically feasible with an intra-operative risk profile comparable to sole kyphoplasty and a shorter treatment time and hospitalisation for the patients compared to conventional multifraction radiation. Radiation could not be applied in 10% of cases due to technical difficulties. The results of this feasibility study permit further evaluation of this new technique by a dose escalation study which is currently in preparation.

A Novel Radiotherapy Approach for Keloids with Intrabeam

“…Postoperative radiotherapy has been demonstrated to be able to reduce the recurrence of keloids and to be safe [8, 9]. A relatively novel photon therapy apparatus, Intrabeam, has been used in the treatment of breast cancer [10], brain cancer [11], rectal cancer [12], and vertebral metastases [13, 14] because of its small size, light weight, ease of transportation, and low operating room protection requirements. As the Intrabeam system (Zeiss Corporation) uses low-energy X-rays, patients require less protection and sustain minimal damage to tissue surrounding the target area.…”

First reported treatment of aggressive hemangioma with intraoperative radiation therapy and kyphoplasty (Kypho-IORT)

“…However, the interest in IORT has increased considerably with the development of novel miniature X-ray generators, with a new needle applicator, designed combining a stainless steel tube to protect the radiation source and a plastic tip that minimizes the absorption of the radiation. The intraoperative treatment during kyphoplasty allows the combination of surgical stabilization for pain relief and radiotherapy for tumor cell sterilization, increasing life expectancy with one minimally invasive treatment, with excellent reported results [20] , [21] , [22] , [23] , [24] .…”

Strahlentherapie von Skelettmetastasen

“…Radiografische Zeichen der Rekalzifizierung finden sich in der Regel nach frühestens sechs Wochen (▶ Abb. (28)(29)(30)(31). Eine Dosis eskalationsstudie (ClinicalTrials.gov: NCT01280032) in der die applizierte Strahlendosis schrittweise gesteigert wurde, konnte kürzlich erfolgreich abgeschlossen werden.…”