Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases

Cardoso, Érico R.; Ashamalla, Hani; Weng, Lijun; Mokhtar, B.; Ali, Shamsah; Macedon, M.; Guirguis, Adel

doi:10.3171/2008.11.spine0856

Cited by 36 publications

(14 citation statements)

References 25 publications

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“…Cardoso et al 7 have described the interstitial delivery of samarium-153 coupled with kyphoplasty for the treatment of vertebral metastases. Similar to our technique, they demonstrated that the combined percutaneous debulking of confined vertebral metastases and the delivery of local radiotherapy for tumor control was feasible and safe.…”

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confidence: 99%

Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

Gerszten¹,

Monaco²

2009

FOC

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Object Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and radiation therapy for the underlying malignant process. Spinal radiosurgery provides excellent long-term radiographic control for vertebral metastases. Percutaneous cement augmentation using polymethylmethacrylate (PMMA) may be contraindicated in lesions with spinal canal compromise due to the risk of displacement of tumor resulting in spinal cord or cauda equina injury. However, there is also significant morbidity associated with open corpectomy procedures in patients with metastatic cancer, especially in those who subsequently require adjuvant radiotherapy. This study evaluated a treatment paradigm for malignant vertebral compression fractures consisting of transpedicular coblation corpectomy combined with closed fracture reduction and fixation, followed by spinal radiosurgery. Methods Eleven patients (6 men and 5 women, mean age 58 years) with symptomatic vertebral body metastatic tumors associated with moderate spinal canal compromise were included in this study (8 thoracic levels, 3 lumbar levels). Primary histologies included 4 lung, 2 breast, 2 renal, and 1 each of thyroid, bladder, and hepatocellular carcinomas. All patients underwent percutaneous transpedicular coblation corpectomy immediately followed by balloon kyphoplasty through the same 8-gauge cannula under fluoroscopic guidance. Patients subsequently underwent radiosurgery to the affected vertebral body (mean time to treatment 14 days). Postoperatively, patients were assessed for pain reduction and neurological morbidity. Results There were no complications associated with any part of the procedure. Adequate cement augmentation within the vertebral body was achieved in all cases. The mean radiosurgical tumor dose was 19 Gy covering the entire vertebral body. The procedure provided long-term pain improvement and radiographic tumor control in all patients (follow-up range 7–44 months). No patient later required open surgery. No radiation-induced toxicity or new neurological deficit occurred during the follow-up period. Conclusions This treatment paradigm for pathological fractures of percutaneous transpedicular corpectomy combined with cement augmentation followed by radiosurgery was found to be safe and clinically effective. This technique combines minimally invasive procedures that avoid the morbidity associated with open surgery while providing spinal canal decompression and immediate fracture stabilization, and then administering a single-fraction tumoricidal radiation dose.

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Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

Gerszten¹,

Monaco²

2009

FOC

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“…Whether metastases in the pedicle can be approached with this technique remains to be determined based on the dose to the spinal cord and the stability of the positioning of the IORT device. External beam radiotherapy or radiosurgery [8,9] even when combined with bisphosphonates do provide improved structural stability only after a prolonged period of time and the hazards of open radionuclides are avoided with this X-ray based approach [10]. A detailed discussion about different fractionation schedules for the treatment of spinal cord metastases can be found in a recent review [11].…”

Section: Discussionmentioning

confidence: 99%

Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases

et al. 2010

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BackgroundInstable and painful vertebral metastases in patients with progressive visceral metastases present a common therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT) during kyphoplasty and report the first treated case.Methods/Results60 year old patient with metastasizing breast cancer under chemotherapy presented with a newly diagnosed painful metastasis in the 12th thoracic vertebra. Under general anaesthesia, a bipedicular approach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electron drift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This was inserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mm distance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated after IORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes.ConclusionIn conclusion, this novel, minimally invasive procedure can be performed in standard operating rooms and may become a valuable option for patients with vertebral metastases providing immediate stability and local control. A phase I/II study is under way to establish the optimal dose prescription.

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“…Care was taken to prevent perforation of the cortical surfaces of the vertebral body during this step. Details of tumor curettage have been previously reported (17).…”

Section: Methodsmentioning

confidence: 99%

Phase I Trial of Vertebral Intracavitary Cement and Samarium (VICS): Novel Technique for Treatment of Painful Vertebral Metastasis

Ashamalla

Cardoso

Macedon

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases

Cited by 36 publications

References 25 publications

Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases

Phase I Trial of Vertebral Intracavitary Cement and Samarium (VICS): Novel Technique for Treatment of Painful Vertebral Metastasis

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