title: Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine.
abstract: OBJECTIVE
  Advances in stereotactic radiosurgery have improved local control of spine metastases, but local failure is still a problem and repeat irradiation is limited by normal tissue tolerance. A novel high-dose-rate (HDR) brachytherapy technique has been developed to treat these previously irradiated lesions.
  
  
  METHODS
  Five patients with progressive disease at previously irradiated sites in the spine who were not amenable to further external beam radiation were treated. Catheters were placed intraoperatively in 2 patients and percutaneously implanted in 3 patients with image-guided techniques. Conformal plans were generated to deliver dose to target tissues and spare critical structures. Patients received single-fraction treatment using HDR iridium-192 brachytherapy.
  
  
  RESULTS
  Median dose was 14 Gy (range, 12-18 Gy) with a median gross total volume D90 of 75% (range, 31-94%); spinal cord/cauda equina dose constraints were met. At a median followup of 9 months, no local progression of disease has been observed. Four patients had reduction in pain 1-4 weeks after treatment. No brachytherapy-related complications have been observed.
  
  
  CONCLUSIONS
  Intraoperative and percutaneous iridium-192 HDR spine brachytherapy techniques were not associated with complications or acute toxicity. There has been no local progression at treated sites, and most patients experienced reduction in cancer-related pain.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Michael R
authors: MR
authors: Folkert
authors: Mark H
authors: MH
authors: Bilsky
authors: Gil'ad N
authors: GN
authors: Cohen
authors: Marco
authors: M
authors: Zaider
authors: Eric
authors: E
authors: Lis
authors: George
authors: G
authors: Krol
authors: Ilya
authors: I
authors: Laufer
authors: Yoshiya
authors: Y
authors: Yamada
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D013904:Thoracic Vertebrae; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes
keywords: Brachytherapy; High-dose-rate; Metastases; Recurrent; Reirradiation; Spine