Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences
Introduction Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay...
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| Veröffentlicht in: | Journal of neuro-oncology 2024-07, Vol.168 (3), p.445-455 |
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| creator | Krauss, P. Wolfert, C. L. Sommer, B. Stemmer, B. Stueben, G. Kahl, K. H. Shiban, E. |
| description | Introduction
Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT.
Methods
Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR.
Results
15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastasis were located in the thoracic (
n
= 11, 73.3%) and the rest in the lumbar (
n
= 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 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 infection (one 65 days after surgery).
Conclusion
50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases. |
| doi_str_mv | 10.1007/s11060-024-04688-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11186943</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3069657988</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-757206d38be1369b25cb532ac8f2fec96a03e62367acdfe24ff710efd6546caf3</originalsourceid><addsrcrecordid>eNp9ksuOFCEUhonROG3rC7gwJG7clHKpgqqVMRMvk0ziRhN3hKIO3UyqoASqtWc1D-Ej-GQ-ibQ9M14WbiDkfP_PgfMj9JiS55QQ-SJRSgSpCKsrUou2regdtKKN5JXkkt9FK0KFrJqu_nSCHqR0QQipJaf30QlvRcNqQlbo-5nPUYcZos5uBzjqwYW8Lcd5j02YeudhwF9c3uI0O69HnLLu3eguCx88TkvcQNz_uPqmsQ87GHGOoPMEPheymMJmj22IN-oJsi4OCRLuyzrg4qGxdTEV3vnNCJUpWogYvpamHHgD6SG6Z_WY4NH1vkYf37z-cPquOn__9uz01XllaiZyJRvJiBh42wPloutZY_qGM21ayyyYTmjCQTAupDaDBVZbKykBO4imFkZbvkYvj77z0k8wHBqJelRzdJOOexW0U39XvNuqTdgpSmkrupoXh2fXDjF8XiBlNblkYBy1h7AkxUndUCq7MqQ1evoPehGWWP7oQIlONLJr20KxI2ViSCmCve2GEnVIgTqmQJUUqF8pULSInvz5jlvJzdgLwI9AKiVfBvj77v_Y_gRmZ8Tj</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3069657988</pqid></control><display><type>article</type><title>Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences</title><source>SpringerLink Journals</source><creator>Krauss, P. ; Wolfert, C. L. ; Sommer, B. ; Stemmer, B. ; Stueben, G. ; Kahl, K. H. ; Shiban, E.</creator><creatorcontrib>Krauss, P. ; Wolfert, C. L. ; Sommer, B. ; Stemmer, B. ; Stueben, G. ; Kahl, K. H. ; Shiban, E.</creatorcontrib><description>Introduction
Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT.
Methods
Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR.
Results
15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastasis were located in the thoracic (
n
= 11, 73.3%) and the rest in the lumbar (
n
= 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 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 infection (one 65 days after surgery).
Conclusion
50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.</description><identifier>ISSN: 0167-594X</identifier><identifier>ISSN: 1573-7373</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-024-04688-1</identifier><identifier>PMID: 38652400</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Brain cancer ; Brain tumors ; Breast carcinoma ; Colorectal cancer ; Colorectal carcinoma ; Decompression ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Morbidity ; Neurology ; Oncology ; Patients ; Radiation therapy ; Spinal cancer ; Spinal cord ; Spine (lumbar) ; Surgery ; Surgical site infections ; Thorax ; Wound healing</subject><ispartof>Journal of neuro-oncology, 2024-07, Vol.168 (3), p.445-455</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-757206d38be1369b25cb532ac8f2fec96a03e62367acdfe24ff710efd6546caf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11060-024-04688-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11060-024-04688-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38652400$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Krauss, P.</creatorcontrib><creatorcontrib>Wolfert, C. L.</creatorcontrib><creatorcontrib>Sommer, B.</creatorcontrib><creatorcontrib>Stemmer, B.</creatorcontrib><creatorcontrib>Stueben, G.</creatorcontrib><creatorcontrib>Kahl, K. H.</creatorcontrib><creatorcontrib>Shiban, E.</creatorcontrib><title>Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences</title><title>Journal of neuro-oncology</title><addtitle>J Neurooncol</addtitle><addtitle>J Neurooncol</addtitle><description>Introduction
Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT.
Methods
Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR.
Results
15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastasis were located in the thoracic (
n
= 11, 73.3%) and the rest in the lumbar (
n
= 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 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 infection (one 65 days after surgery).
Conclusion
50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.</description><subject>Brain cancer</subject><subject>Brain tumors</subject><subject>Breast carcinoma</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>Decompression</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Morbidity</subject><subject>Neurology</subject><subject>Oncology</subject><subject>Patients</subject><subject>Radiation therapy</subject><subject>Spinal cancer</subject><subject>Spinal cord</subject><subject>Spine (lumbar)</subject><subject>Surgery</subject><subject>Surgical site infections</subject><subject>Thorax</subject><subject>Wound healing</subject><issn>0167-594X</issn><issn>1573-7373</issn><issn>1573-7373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><recordid>eNp9ksuOFCEUhonROG3rC7gwJG7clHKpgqqVMRMvk0ziRhN3hKIO3UyqoASqtWc1D-Ej-GQ-ibQ9M14WbiDkfP_PgfMj9JiS55QQ-SJRSgSpCKsrUou2regdtKKN5JXkkt9FK0KFrJqu_nSCHqR0QQipJaf30QlvRcNqQlbo-5nPUYcZos5uBzjqwYW8Lcd5j02YeudhwF9c3uI0O69HnLLu3eguCx88TkvcQNz_uPqmsQ87GHGOoPMEPheymMJmj22IN-oJsi4OCRLuyzrg4qGxdTEV3vnNCJUpWogYvpamHHgD6SG6Z_WY4NH1vkYf37z-cPquOn__9uz01XllaiZyJRvJiBh42wPloutZY_qGM21ayyyYTmjCQTAupDaDBVZbKykBO4imFkZbvkYvj77z0k8wHBqJelRzdJOOexW0U39XvNuqTdgpSmkrupoXh2fXDjF8XiBlNblkYBy1h7AkxUndUCq7MqQ1evoPehGWWP7oQIlONLJr20KxI2ViSCmCve2GEnVIgTqmQJUUqF8pULSInvz5jlvJzdgLwI9AKiVfBvj77v_Y_gRmZ8Tj</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Krauss, P.</creator><creator>Wolfert, C. L.</creator><creator>Sommer, B.</creator><creator>Stemmer, B.</creator><creator>Stueben, G.</creator><creator>Kahl, K. H.</creator><creator>Shiban, E.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240701</creationdate><title>Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences</title><author>Krauss, P. ; Wolfert, C. L. ; Sommer, B. ; Stemmer, B. ; Stueben, G. ; Kahl, K. H. ; Shiban, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-757206d38be1369b25cb532ac8f2fec96a03e62367acdfe24ff710efd6546caf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Brain cancer</topic><topic>Brain tumors</topic><topic>Breast carcinoma</topic><topic>Colorectal cancer</topic><topic>Colorectal carcinoma</topic><topic>Decompression</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Morbidity</topic><topic>Neurology</topic><topic>Oncology</topic><topic>Patients</topic><topic>Radiation therapy</topic><topic>Spinal cancer</topic><topic>Spinal cord</topic><topic>Spine (lumbar)</topic><topic>Surgery</topic><topic>Surgical site infections</topic><topic>Thorax</topic><topic>Wound healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Krauss, P.</creatorcontrib><creatorcontrib>Wolfert, C. L.</creatorcontrib><creatorcontrib>Sommer, B.</creatorcontrib><creatorcontrib>Stemmer, B.</creatorcontrib><creatorcontrib>Stueben, G.</creatorcontrib><creatorcontrib>Kahl, K. H.</creatorcontrib><creatorcontrib>Shiban, E.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Krauss, P.</au><au>Wolfert, C. L.</au><au>Sommer, B.</au><au>Stemmer, B.</au><au>Stueben, G.</au><au>Kahl, K. H.</au><au>Shiban, E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences</atitle><jtitle>Journal of neuro-oncology</jtitle><stitle>J Neurooncol</stitle><addtitle>J Neurooncol</addtitle><date>2024-07-01</date><risdate>2024</risdate><volume>168</volume><issue>3</issue><spage>445</spage><epage>455</epage><pages>445-455</pages><issn>0167-594X</issn><issn>1573-7373</issn><eissn>1573-7373</eissn><abstract>Introduction
Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT.
Methods
Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR.
Results
15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastasis were located in the thoracic (
n
= 11, 73.3%) and the rest in the lumbar (
n
= 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 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 infection (one 65 days after surgery).
Conclusion
50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38652400</pmid><doi>10.1007/s11060-024-04688-1</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | SpringerLink Journals |
| subjects | Brain cancer Brain tumors Breast carcinoma Colorectal cancer Colorectal carcinoma Decompression Medicine Medicine & Public Health Metastases Metastasis Morbidity Neurology Oncology Patients Radiation therapy Spinal cancer Spinal cord Spine (lumbar) Surgery Surgical site infections Thorax Wound healing |
| title | Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences |
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