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

Radiat Oncol. 2010 Feb 11;5:11. doi: 10.1186/1748-717X-5-11.

Abstract

Background: Instable 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/results: 60 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.

Conclusion: In 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.

Publication types

  • Case Reports

MeSH terms

  • Breast Neoplasms / pathology
  • Combined Modality Therapy
  • Female
  • Humans
  • Intraoperative Period
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Radiotherapy / methods*
  • Spinal Neoplasms / radiotherapy*
  • Spinal Neoplasms / secondary
  • Spinal Neoplasms / surgery*
  • Thoracic Vertebrae / surgery
  • Vertebroplasty*