Clinical investigations on the spinal osteoblastic metastasis treated by combination of percutaneous vertebroplasty and (125)I seeds implantation versus radiotherapy

Abstract

To investigate the clinical efficacy of combining digital subtraction angiography-guided percutaneous vertebroplasty (PVP) and (125)I seeds implantation for the treatment of spinal osteoplastic metastasis. A combination of PVP and (125)I implantation was conducted for 50 patients with spinal osteoplastic metastasis, while the other 50 patients who received regular radiation therapy were used as a comparison. Visual analogue pain scale (VAS) and score of life quality (EORTCQLQ-30) were determined for all the patients. Surgery was successful in 89 spinal segments of vertebral body in 50 patients. Each segment of vertebral body was injected with 1-5 mL (2.8 mL for thoracic and 3.1 mL for lumbar vertebral body on average) of bone cement. Postoperative X-ray and CT examination showed that all the patients in the PVP group achieved spinal stability. During the follow-up examination from 6 months to 5 years, 49 patients (98.0%) had significantly relieved back pain, and only 1 case (2.0%) had no obvious improvement. Postoperative VAS score and Karnofsky performance score (KPS) were significantly different from the preoperative scores (p<0.05); and compared to the regular treatment group, PVP combined (125)I seeds showed much better clinical efficacy (p<0.05). PVP is a minimally invasive treatment with easy operation and less complications. PVP can effectively relieve the pain, stabilize the spine, improve the life quality, and reduce the occurrence of paraplegia in patients with spinal osteoplastic metastasis. Utilization of (125)I seeds with PVP can enhance the clinical efficacy.

FIG. 1.

Therapy plan system and determination of the prescription dosage in the target areas. (A) Determination of the prescription dosage in the target areas; (B) Determination of maximum tolerant dosage of spinal cord.

FIG. 2.

T11 osteoblastic metastasis from right lung cancer. During implantation of ¹²⁵I seeds, one side of the needle was directed to the mid-upper part of the vertebral body, while the other side of the needle was directed to the mid-lower part of the vertebral body. The ¹²⁵I seeds were distributed in the vertebral body in a 3D manner.

FIG. 3.

Treatment of T9 osteoblastic metastasis from left breast cancer with combination of PVP and implantation of ¹²⁵I seeds during surgery (A) and after surgery (B). Digital subtraction angiography showed that ¹²⁵I seeds were well distributed and bone cement was well filled. PVP, percutaneous vertebroplasty.

FIG. 4.

Treatment of T9 osteoblastic metastasis from left breast cancer with combination of PVP and implantation of ¹²⁵I seeds during surgery (A) and after surgery (B). CT examination showed that bone cement was distributed in a diffusion manner.

FIG. 5.

Treatment of T5 osteoblastic metastasis from right testicular seminoma with combination of PVP and implantation of ¹²⁵I seeds during surgery (A) and after surgery (B). CT examination showed that bone cement was well filled.