F Bludau1, T Reis2, F Schneider2, S Clausen2, F Wenz2, U Obertacke3. 1. Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland. Frederic.Bludau@umm.de. 2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland. 3. Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland.
Abstract
BACKGROUND: Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. METHOD AND RESULTS: Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. CONCLUSION: The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.
BACKGROUND: Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. METHOD AND RESULTS: Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. CONCLUSION: The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.
Authors: Frederik Wenz; Frank Schneider; Christian Neumaier; Uta Kraus-Tiefenbacher; Tina Reis; René Schmidt; Udo Obertacke Journal: Radiat Oncol Date: 2010-02-11 Impact factor: 3.481
Authors: Marcelo V R Cunha; Ameen Al-Omair; Eshetu G Atenafu; Giuseppina Laura Masucci; Daniel Letourneau; Renee Korol; Eugene Yu; Peter Howard; Fiona Lochray; Leodante B da Costa; Michael G Fehlings; Arjun Sahgal Journal: Int J Radiat Oncol Biol Phys Date: 2012-06-01 Impact factor: 7.038
Authors: Arjun Sahgal; Eshetu G Atenafu; Sam Chao; Ameen Al-Omair; Nicholas Boehling; Ehsan H Balagamwala; Marcelo Cunha; Isabelle Thibault; Lilyana Angelov; Paul Brown; John Suh; Laurence D Rhines; Michael G Fehlings; Eric Chang Journal: J Clin Oncol Date: 2013-08-19 Impact factor: 44.544