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

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

Author information

1
Department of Radiation Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany. frederik.wenz@umm.de

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.

PMID:
20149237
PMCID:
PMC2829586
DOI:
10.1186/1748-717X-5-11
[Indexed for MEDLINE]
Free PMC Article

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