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


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.


CONCLUSIONS
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.
Department of Radiation Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany. frederik.wenz@umm.de
Frederik
F
Wenz
Frank
F
Schneider
Christian
C
Neumaier
Uta
U
Kraus-Tiefenbacher
Tina
T
Reis
René
R
Schmidt
Udo
U
Obertacke
D001943:Breast Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011878:Radiotherapy / Q000379:methods*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery; D054854:Vertebroplasty