Bludau F, Reis T, Schneider F, Clausen S, Wenz F, Obertacke U
Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland.
Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland.
Radiologe. 2015 Oct;55(10):859-67. doi: 10.1007/s00117-015-0018-1.
Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients.
Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated.
The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.
由于更有效的全身治疗，恶性肿瘤患者的生存率得到了显著提高，但寿命延长往往伴随着骨转移发生率的升高。这些转移瘤大多位于脊柱，会引起疼痛、不稳定和神经功能障碍。脊柱转移瘤的多学科管理以前包括稳定化治疗，随后进行分次体外放射治疗。降低手术严重程度和发病率以及考虑患者的自理能力和住院时间是这些姑息治疗患者的重要目标参数。
椎体后凸成形术联合术中放疗（Kypho-IORT）是几种现代治疗选择之一，它是一种微创手术，通过低能量（50 kV）X射线经椎弓根对脊柱进行局部高剂量照射。照射后立即通过相同的入路进行椎体后凸成形术以稳定脊柱，从而实现单阶段手术，达到良好的止痛效果和局部肿瘤控制。本文介绍了该手术的临床数据，并对不同的适应证领域进行了批判性回顾，并与其他治疗选择进行了比较。展示了方法学的改进和进一步个体化治疗的选择。
Kypho-IORT手术是一种安全、可行且有益的现代治疗选择，可用于脊柱转移瘤患者的即时稳定和局部肿瘤控制。已经成功进行了100多例手术，因此该方法可被认为适合纳入临床常规。目前一项II期剂量递增研究已完成并提交发表，一项与传统放疗比较的双臂非劣效性试验（III期研究）正在进行中。
