Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

Abstract

Introduction The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date. Methods Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually. Results A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4–109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5–73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported. Conclusion In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects.

Paradigmenwechsel in der Tumorchirurgie der Wirbelsäule – von der Radiofrequenzablation und Kypho-IORT zu Separation Surgery und MIS-Instrumentation. Wo stehen wir? Therapiealgorithmus und Evidenz

“…Die lokale Tumorkontrolle zeigte sich in einem Single-Center Kollektiv mit 96% für 12 Monate sehr gut [17]. Das Phänomen der Radioresistenz zeigte sich nicht.…”

“…Die RFA zeigte gute Ergebnisse bei der Anwendbarkeit, der Zugangsmorbidität und der raschen Schmerzreduktion, vergleichbar mit dem Einsatz der Kyphoplastie allein [15,16], allerdings ist die RFA als alleinige Intervention zur Verbesserung der Wirbelkörperstabilität ineffizienter als z. B. die Kyohoplastie/ Vertebroplastie oder die Kypho-IORT [5,17], sodass die RFA für die meisten Patienten mit der Kyphoplastie/Vertebroplastie kombiniert werden sollte.…”

Balloon kyphoplasty as palliative care for painful pathological spinal fracture followed by lung cancer metastasis: A cohort study

“…Compared with PVP, PKP is more effective in restoring kyphosis due to the propulsive effect of the balloon ( 6 ). Inspiringly, the mechanical support would not be affected by the tumor and the following therapies (radiotherapy and chemotherapy) ( 3 , 10 , 15 , 16 ). Due to the major influence of kyphosis on pulmonary functions, a further increase in kyphosis may affect breathing and ultimately decrease the patient's end-stage life quality.…”

Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis

“…Furthermore, unlike this study, most currently available data on PMV in the field of cancer treatment do not specifically focus on the subgroup of patients who underwent oncological surgery. Not all patients with SM are treated surgically: particularly in the case of small, non-space occupying tumors of the spinal canal or multiple asymptomatic findings, other treatment options are well established ( 52 – 56 ). Along these lines, the subgroup of patients with SM and additional surgical treatment are supposed be at a high risk of postoperative PMV.…”