Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT)

Schneider, Frank; Greineck, Fabian; Clausen, Sven; Mai, Sabine; Obertacke, U.; Reis, Tina; Wenz, Frederik

doi:10.1016/j.ijrobp.2010.07.1985

Cited by 48 publications

(46 citation statements)

References 37 publications

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“…Based on the findings by Rose et al [20], patients with osteolytic lesions of >40% or a lesion above T10 could be candidates for prophylactic stabilization, preferably by minimally invasive cement augmentation. Schneider et al [21], based on similar assumptions, calculated a potential of 34% of patients with spinal metastases eligible for Kypho-IORT. As more patients will experience spinal metastasis due to higher life expectancy in metastatic cancer, it seems likely that the significance of Kypho-IORT in spinal metastases could increase.…”

Section: Discussionmentioning

confidence: 99%

“…The rest of the procedure is a standard kyphoplasty with inflation of the balloon followed by cement application. Once the technical requirements were understood, a calculation and cadaver study was performed [21]. The results were evaluated by the local ethics committee and the Federal Office for Radiation Protection, which gave permission for the study in a standard operating room without specific radiation protection requirements, due to the steep dose decrease with practically no radiation at the body surface.…”

Section: Methodsmentioning

confidence: 99%

“…We therefore established the technical requirements for a combined kyphoplasty and intra-operative radiation therapy (Kypho-IORT). After thorough theoretical and cadaver studies [21] a clinical feasibility study was conducted prior to the planning of a long-term outcome study. The results of this clinical feasability study are presented here.…”

Section: Introductionmentioning

confidence: 99%

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

Schmidt

Wenz

Reis

et al. 2012

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Schmidt

Wenz

Reis

et al. 2012

International Orthopaedics (SICOT)

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“…A recent publication by Schneider F et al addressed the utility of intraoperative radiotherapy using the INTRABEAM system during kypohoplasty for spinal metastases [21]. Though most treatments still occur in the setting of spinal or paraspinal metastases, there is a strong possibility that such treatment techniques will become applicable to lesions in other areas of the body.…”

Section: Discussionmentioning

confidence: 99%

A Single-Dose Conformal Delivery of Radiotherapy following Osteoplasty

Wernicke

Sabbas

Kulidzhanov

et al. 2012

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Multiple myeloma (MM) is a very radiosensitive tumor. Fractionated external beam radiation, which takes approximately 2 weeks of therapy, is typically used to irradiate myelomatous bone lesions with the goal of palliation. However, traditional radiotherapeutic techniques are not only lengthy but they also involve a considerable amount of healthy bone marrow in the treatment ports, which may undermine the total marrow reserve of a patient. Because of the limited survival time of patients with metastatic cancer, novel treatment concepts shortening the overall treatment time is desirable. We present an innovative approach of delivering targeted intra-operative radiotherapy to a solitary osteolytic metastasis in one application, while sparing healthy bone marrow from radiation toxicity and substantially reducing the overall treatment time. A 78-year-old Caucasian male with MM, previously treated with chemotherapy, who was off chemotherapy for 2 years due to bone marrow suppression, presented with a solitary recurrence at the left anterior superior iliac spine of the left iliac wing as diagnosed by PET-CT scan. This lesion was treated with a minimally invasive osteoplasty and intra-operative brachytherapy with to a dose of 8 Gy delivered to the surgical cavity only, followed by injection of the bone cement into the cavity. Three months after the procedure, the area of treatment demonstrated no uptake on a follow-up PET-CT scan. At 1.5 years after this procedure, 100% local control continues to persist in the treated area, as evidenced on nuclear imaging. To our knowledge, this is the first case of using focal intraoperative brachytherapy confined to the area of the pelvis in a patient treated for a solitary metastasis from MM. The purpose of the article is to present a novel approach as a more convenient and focal treatment of bony lesions of MM.

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“…11 For kyphoplasty, however, Monte Carlo simulation was used to characterize dose to the bone when developing the technique, 60 and the close proximity of critical organs makes individual calculation potentially useful. In addition, modulation of energy and dwell times to give intensitymodulated brachytherapy is only practical with rapid and accurate dose calculation for individual patients.…”

Section: Treatment Planningmentioning

confidence: 99%

Electronic brachytherapy—current status and future directions

Eaton¹

2015

BJR

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In the past decade, electronic brachytherapy (EB) has emerged as an attractive modality for the treatment of skin lesions and intraoperative partial breast irradiation, as well as finding wider applications in intracavitary and interstitial sites. These miniature X-ray sources, which operate at low kilovoltage energies (,100 kV), have reduced shielding requirements and inherent portability, therefore can be used outside the traditional realms of the radiotherapy department. However, steep dose gradients and increased sensitivity to inhomogeneities challenge accurate dosimetry. Secondly, ease of use does not mitigate the need for close involvement by medical physics experts and consultant oncologists. Finally, further studies are needed to relate the more heterogeneous dose distributions to clinical outcomes. With these provisos, the practical convenience of EB strongly suggests that it will become an established option for selected patients, not only in radiotherapy departments but also in a range of operating theatres and clinics around the world.

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Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT)

Cited by 48 publications

References 37 publications

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

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

A Single-Dose Conformal Delivery of Radiotherapy following Osteoplasty

Electronic brachytherapy—current status and future directions

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