Micro-invasive surgery combined with intraoperative radiotherapy for the treatment of spinal metastasis.
This is a retrospective analysis of the strategy and clinical results of surgery combined with intraoperative radiotherapy (IORT) to treat spinal metastases.



We delivered tumour-conformal IORT in 40 patients with 52 metastatic vertebrae based on our surgical classification system. The strategies were evaluated with respect to neurologic function and spinal stability. The EORTC QLQ-BM22, visual analogue scale (VAS) and the Frankel Scale were used to assess quality of life, pain and neurologic function. Local control was evaluated every 3 months using X-rays and MRI.



Micro-invasive IORT was performed in 42 vertebrae (80.8%), and open surgery with IORT was performed in 10 vertebrae (19.2%). Single-level, 2-level and 3-level IORT was performed in 30, 8 and 2 cases, respectively. The delivered dose was 9.2 ± 3.6 Gy (8-15 Gy) with a depth of 10.1 ± 2.1 mm. The actual IORT treatment time was 5 min and 16 s. The follow-up period was 6-23 months (mean: 12.5 months). The local control rate was 92.3%. The EORTC QLQ-BM22 scores showed that patients had significant improvements in pain location, degree and function after treatment (P < 0.01). Thirty-five patients (89.7%) achieved pain relief throughout the follow-up period. VAS scores were significantly reduced by 3.4 points 3 months after treatment. Neurological function was improved in 7 patients (87.5%). No radiation-related complications were observed.



Surgery combined with tumour-conformal IORT can effectively relieve pain, achieve good local control and improve QOL.
Department of Orthopaedics, Research Center of Spinal and Pelvic Tumour, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.|Research Institute for Spinal Cord Injury of Sun Yat-sen University, Guangzhou, 510120, China.|Research Center of Spinal and Spinal Cord Disease, Guangzhou, 510120, China.
Keng
K
Chen
Department of Orthopaedics, Research Center of Spinal and Pelvic Tumour, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.|Research Institute for Spinal Cord Injury of Sun Yat-sen University, Guangzhou, 510120, China.|Research Center of Spinal and Spinal Cord Disease, Guangzhou, 510120, China.
Lin
L
Huang
Department of Orthopaedics, Research Center of Spinal and Pelvic Tumour, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.|Research Institute for Spinal Cord Injury of Sun Yat-sen University, Guangzhou, 510120, China.|Research Center of Spinal and Spinal Cord Disease, Guangzhou, 510120, China.
Zhaopeng
Z
Cai
Radiotherapy Department of Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Juntian
J
Shi
Radiotherapy Department of Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Kaiyun
K
You
Department of Orthopaedics, Research Center of Spinal and Pelvic Tumour, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, China. shenhuiyong@aliyun.com.|Research Institute for Spinal Cord Injury of Sun Yat-sen University, Guangzhou, 510120, China. shenhuiyong@aliyun.com.|Research Center of Spinal and Spinal Cord Disease, Guangzhou, 510120, China. shenhuiyong@aliyun.com.
Huiyong
H
Shen
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D016896:Treatment Outcome
Clinical result; Intraoperative radiotherapy; Micro-invasive; Vertebral metastasis