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Intraoperative radiotherapy combined with spinal stabilization surgery-a novel treatment strategy for spinal metastases based on a first single-center experiences – Lumbar Spinal Stenosis

The article discusses a novel treatment protocol for spinal metastases (SM) that combines stabilization surgery with intraoperative radiotherapy (IORT). The study conducted on 15 patients showed that using a carbon screw-rod system followed by 50 kV photon-IORT was safe and feasible, with promising results in selected cases. The procedure involved single session stabilization using navigation-guided procedures, with most metastases located in the thoracic spine. Although some patients experienced adverse events, overall the treatment was considered successful in addressing spinal stability and achieving local control in patients with SM. The findings suggest that 50 kV photon IORT could be a valuable technique in managing unstable spines in patients with spinal metastases

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top spine clinic in UK

Published article

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.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
J Neurooncol. 2024 Apr 23. doi: 10.1007/s11060-024-04688-1. Online ahead of print. 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,

J Neurooncol. 2024 Apr 23. doi: 10.1007/s11060-024-04688-1. Online ahead of print.

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.

PMID:38652400 | DOI:10.1007/s11060-024-04688-1

The London Spine Unit : top spine clinic in UK

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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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J Neurooncol. 2024 Apr 23. doi: 10.1007/s11060-024-04688-1. Online ahead of print. 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

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