Intraoperative Radiation for Spinal Metastatic Disease

Imber, Brandon S.; Folkert, Michael R.; Yamada, Yoshiya

doi:10.1007/978-3-030-42958-4_50

Cited by 1 publication

(3 citation statements)

References 39 publications

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“…Previous studies have reported the use of permanent intratumoral iodine-125 low-dose rate seed placement. 18,19 We opted for HDR brachytherapy with temporary implantation of 192 Ir HDR brachytherapy has several advantages including the flexibility of radiation dose optimization to maximize dose to the CTV while minimizing dose to the surrounding OARs after catheter placement. Additionally, patients are not radioactive after the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Literature on the topic reveals variations in both the radioisotopes used and methods for placement of brachytherapy implants. 18,19 Computed tomography (CT)-based placement has been the preferred approach for placement of catheters. 20,21,24,25 However, CT-based methods have primarily been used to optimize preimplant planning and confirm desired implant placements.…”

mentioning

confidence: 99%

“…3,[11][12][13][14][15][16][17] High-dose rate (HDR) interstitial brachytherapy is a treatment option for spinal metastases. 18 HDR brachytherapy has the ability to deliver ablative radiation dose to spinal metastatic targets. 19,20 Most importantly, HDR brachytherapy for refractory spine metastases is suggested to improve tumor associated pain symptoms and patient performance status scores.…”

mentioning

confidence: 99%

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High-Dose Rate Interstitial Spine Brachytherapy Using an Intraoperative Mobile Computed Tomography-Guided Surgical Navigation System

Medina¹,

Macyszyn²,

Lim³

et al. 2021

ONSURG

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BACKGROUND Up to 15% of previously irradiated metastatic spine tumors will progress. Re-irradiation of these tumors poses a significant risk of exceeding the radiation tolerance to the spinal cord. High-dose rate (HDR) brachytherapy is a treatment alternative. OBJECTIVE To develop a novel HDR spine brachytherapy technique using an intraoperative computed tomography-guided navigation (iCT navigation). METHODS Patients with progressive metastatic spine tumors were included in the study. HDR brachytherapy catheters were placed under iCT navigation. CT-based planning with magnetic resonance imaging fusion was performed to ensure conformal dose delivery to the target while sparing normal tissue, including the spinal cord. Patients received single fraction radiation treatment. RESULTS Five patients with thoracolumbar tumors were treated with HDR brachytherapy. Four patients previously received radiotherapy to the same spinal level. Preimplant plans demonstrated median clinical target volume (CTV) D90 of 116.5% (110.8%-147.7%), V100 of 95.7% (95.5%-99.6%), and Dmax of 8.08 Gy (7.65-9.8 Gy) to the spinal cord/cauda equina. Postimplant plans provided median CTV D90 of 113.8% (93.6%-120.1%), V100 of 95.9% (87%-99%), and Dmax of 9.48 Gy (6.5-10.3 Gy) to cord/cauda equina. Patients who presented with back pain (n = 3) noted symptomatic improvement at a median follow-up of 22 d after treatment. Four patients demonstrated local tumor control of spinal metastatic tumor at a median follow-up of 92 d after treatment. One patient demonstrated radiographic evidence of local tumor progression 2.7 mo after treatment. CONCLUSION HDR spine brachytherapy with iCT navigation is a promising treatment alternative to induce local tumor control and reduce pain symptoms associated with metastatic spine disease.

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Section: Discussionmentioning

confidence: 99%