Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors
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SHORT REPORT
Long‑term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho‑IORT) for vertebral tumors Frederic Bludau1†, Laura Winter1†, Grit Welzel2, Udo Obertacke1, Frank Schneider2, Frederik Wenz3, Arne Mathias Ruder2*† and Frank A. Giordano2,4†
Abstract Introduction: The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date. Methods: Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually. Results: A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4–109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5–73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported. Conclusion: In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects. Keywords: Kypho-IORT, Electronic brachytherapy, Intraoperative radiotherapy, Kyphoplasty, Spine, Vertebral metastases
*Correspondence: [email protected] † Frederic Bludau, Laura Winter, Arne Mathias Ruder, and Frank A. Giordano have contributed equally to this work and share the first authorship or the last authorship 2 Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany Full list of author information is available at the end of the article
Introduction The spine is the most common site for the occurrence of bone metastases [1]. Additionally, intraosseous hemangiomas frequently occur as benign tumors of the spine [2]. Treatment should focus on palliation of pain, stabilization and local tumor control with therapeutic options including radiation therapy, surgical intervention or radiofrequency ablation [3–5]. Due to continuous advancements in systemic cancer therapy, any delay or pause of systemic treatment caused by local interventions should
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