Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
Department of Radio Oncology, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
J Neurooncol. 2024 Jul;168(3):445-455. doi: 10.1007/s11060-024-04688-1. Epub 2024 Apr 23.
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.
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.
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).
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.
目前，脊柱转移瘤（SM）的治疗旨在保持脊柱稳定性、神经功能和功能状态，并实现局部控制。其治疗方法包括脊柱手术、放疗和/或全身治疗。辅助治疗通常在几周后开始，以防止伤口愈合问题。术中放疗（IORT）已成功应用于脑肿瘤、乳腺癌和结直肠癌手术中，但尚未应用于 SM，包括不稳定型 SM，截至目前。在我们的病例系列中，我们描述了一种新的治疗方案的可行性、发病率和死亡率，该方案将脊柱稳定手术与 IORT 相结合用于治疗 SM。
对 SM 患者进行单中心病例系列研究。采用导航开放性或经皮手术，使用碳纤维螺钉-棒系统，然后进行单次 50kV 光子 IORT（蔡司 Intrabeam）治疗。通过导航放置 IORT 探头，使用导航定位，通过 IOCT 或 3D 荧光透视控制定位，以实现在手术室进行 RT 等剂量规划。
2022 年 7 月至 2023 年 9 月，共 15 名（8 名女性，71±10 岁）患者接受了这种治疗。脊柱肿瘤不稳定评分中位数为 8[7-10]，IQR。大多数转移位于胸椎（n=11，73.3%），其余位于腰椎（n=4，26.7%）。9 名（60%）患者接受开放性手术，5 名（33%）接受经皮固定术，1 名（7%）仅接受减压术。手术平均时长为 157±45 分钟。11 名患者放置了 8 枚螺钉，3 名患者放置了 4 枚螺钉。由于导筒弯曲，导致 IORT 连续中断，有 2 名患者的放疗无法完成。所有其他患者均接受 8Gy 等剂量照射，深度中位数为 1.5cm[1.1-1.9，IQR]，时间为 2-6 分钟。患者的硬膜脊髓压迫评分在 1a-3 之间。7 名患者（46.7%）发生不良事件，包括 2 例手术部位感染（1 例发生在术后 65 天）。
对于需要手术干预的 SM 和不稳定脊柱，50kV 光子 IORT 是安全可行的，在某些情况下可能是一种有前途的技术。
