Department of Radiation Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
Radiat Oncol. 2010 Feb 11;5:11. doi: 10.1186/1748-717X-5-11.
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.
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.
患有进行性内脏转移的患者中不稳定和疼痛的椎体转移是一个常见的治疗难题。我们开发了一种在椎体成形术中提供术中放疗（IORT）的新方法，并报告了首例治疗病例。
方法/结果：一名 60 岁的转移性乳腺癌患者正在接受化疗，新诊断出第 12 胸椎疼痛转移。全身麻醉下，选择双足入路进入椎体，插入特殊设计的金属套管，以引导微型 X 射线发生器（INTRABEAM，卡尔蔡司手术公司，Oberkochen，德国）的电子漂移管。插入一种为这种方法设计的新型薄片，以保护漂移管。在 5 毫米距离（50 kV X 射线）下输送 8 Gy 的剂量。IORT 后，膨胀了椎体成形球囊（KyphX，Kyphon Inc，Sunnyvale）并注入聚甲基丙烯酸甲酯水泥。整个过程耗时不到 90 分钟。
总之，这种新的微创方法可以在标准手术室进行，可能成为椎体转移患者的有价值选择，提供即时稳定性和局部控制。一项 I/II 期研究正在进行中，以确定最佳剂量方案。
