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. 2020 Nov 12;15(1):263.
doi: 10.1186/s13014-020-01715-z.

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

Frederic Bludau  1 , Laura Winter  1 , Grit Welzel  2 , Udo Obertacke  1 , Frank Schneider  2 , Frederik Wenz  3 , Arne Mathias Ruder  4 , Frank A Giordano  2   5
Affiliations

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

Frederic Bludau et al. Radiat Oncol. .

Abstract

Introduction: The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date.

Methods: Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually.

Results: A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4-109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5-73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported.

Conclusion: In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects.

Keywords: Electronic brachytherapy; Intraoperative radiotherapy; Kypho-IORT; Kyphoplasty; Spine; Vertebral metastases.

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Conflict of interest statement

LW, GW, UO, FW and AMR have no competing interests to disclose. FB and FS report grants and personal fees from Carl Zeiss Meditec AG, during the conduct of the study; FG reports grants, personal fees, and patents from or related to Carl Zeiss Meditec AG, grants from Elekta AB; grants and personal fees from NOXXON Pharma AG, personal fees from Bristol-Myers Squibb, personal fees from Roche Pharma AG, personal fees from MSD Sharp and Dohme GmbH, personal fees from AstraZeneca GmbH, non-financial support from Oncare GmbH, outside the submitted work.

Figures

Fig. 1
Fig. 1
Local control after Kypho-IORT. Shown are the Kaplan–Meier plots for 89 vertebrae of the thoracic spine and 53 vertebrae of the lumbar spine as well as a combined plot of thoracic, lumbar, and sacral vertebrae treated with Kypho-IORT at our institution (the single patient with a treatment of 1 vertebra of the sacral spine died after 6 weeks and cannot be displayed as curve in the graph)
Fig. 2
Fig. 2
Overall survival after Kypho-IORT. Displayed is the overall survival of 104 patients as Kaplan–Meier plot
See this image and copyright information in PMC

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