KEY TAKEAWAYS
- The study aimed to investigate the feasibility and outcomes of combining stabilization surgery with IORT for SM, focusing on safety, efficacy, and overall treatment impact.
- Researchers noticed that 50 kV photon IORT for SM and unstable spine surgery is safe and feasible and shows promise for selected cases.
Managing spinal metastases (SM) requires a delicate balance. Treatment aims to preserve spinal stability, neurological function, and physical capabilities while controlling tumor growth. Traditionally, surgery is followed by separate radiotherapy and/or systemic therapy, often delayed to allow wound healing. Intraoperative radiotherapy (IORT), proven successful with brain cancers and other types of cancers during surgery, has yet to be explored extensively for SM, especially unstable cases needing surgery.
P. Krauss and the team aimed to examine the feasibility, morbidity, and mortality of a novel treatment protocol for SM, combining stabilization surgery with IORT.
Researchers performed an inclusive analysis on patients with SM undergoing a single-session stabilization procedure using a carbon screw-rod system, either navigated open or percutaneous, followed by concurrent 50 kV photon IORT using the ZEISS Intrabeam system. The IORT probe was positioned via a guide canula using navigation, with positioning controlled by intraoperative CT or 3D fluoroscopy to facilitate real-time isodose planning in the operating room.
About 15 patients (8 female, mean age 71 ± 10 years) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastases were located in the thoracic (n = 11, 73.3%) and the rest in the lumbar (n = 4, 26.7%) spine. Nine (60%) patients received open, 5 (33%) percutaneous stabilization, and 1 (7%) decompression only.
The mean length of surgery was 157 ± 45 min. Eleven patients had 8 screws placed, while 3 had 4 screws placed. In 2 patients, radiotherapy was not completed due to the bending of the guide canula with the consecutive abortion of IORT. All other patients received 8 Gy isodoses at a median 1.5 cm [1.1–1.9, IQR] depth during 2-6 min. The patients had Epidural Spinal Cord Compression score 1a-3. Seven patients (46.7%) experienced adverse events, including 2 surgical site infections (one 65 days after surgery).
The study concluded that 50 kV photon IORT for SM and subsequent unstable spine requiring surgical intervention is safe, feasible, and shows promise as a technique in selected cases.
Open Access funding was provided by the Projekt DEAL.
Source: https://link.springer.com/article/10.1007/s11060-024-04688-1
Krauss, P., Wolfert, C.L., Sommer, B. et al. (2024) “ Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04688-1
