Assessment of Spinal Tumor Treatment Using Implanted 3D-Printed Vertebral Bodies with Robotic Stereotactic Radiotherapy

Abstract

To investigate the feasibility and early efficacy of 3D-printed vertebral body implantation combined with robotic radiosurgery in the treatment of spinal tumors. This study included 14 patients with spinal tumors from December 2017 to June 2018. Before surgery, all patients were subjected to CT scan and 3D data of the corresponding vertebral segments were collected. Titanium alloy formed 3D-printed vertebral body implantation and robotic stereotactic radiotherapy were performed because of the risk of postoperative residual, high risk of recovery, or recurrence after surgery. The main outcomes included the remission of symptoms, vertebral body stability, robotic stereotactic surgical precision, and local tumor control. All patients received complete and successful combination therapy, and all healed primarily without complications. The error of the coverage accuracy for robotic radiosurgery was less than 0.5 mm, and the error of the rotation angle was less than 0.5°. The therapeutic toxicity was limited (mainly in grades 1-2), and adverse events were uncommon. The evaluation of vertebral body stability and histocompatibility for all patients met the postoperative clinical requirements. For patients with post spinal injury, the pain symptoms were reduced or disappeared (93%), and nerve function was improved or even recovered after treatment (100%). During our follow-up period, most tumors were locally well controlled (93%). 3D- printed vertebral body implantation combined with robotic radiosurgery may offer a new treatment of spinal tumors. Chinese clinical trial registry: ChiCTR-ONN-17013946.

Keywords: 3D-printed technology; robotic stereotactic radiotherapy; spinal tumor; vertebral body implantation.

Graphical abstract

Figure 1

A Typical Patient Treated with 3D-Printed Vertebral Body Implantation Combined with Robotic Stereotactic Radiotherapy. (A) Patient with five impaired segments. (B) The vertebral body resection of the five impaired segments. (C) Vertebral body implantation. (D) The plan of stereotactic robotic radiotherapy treatment. A, anterior; P, posterior; H, head; F, foot.

Figure 2

Therapeutic Accuracy of Robotic Stereotactic Radiotherapy in All Patients. RGT: left and right move horizontally, LET (+)/RIG (−); ANT: anterior and posterior move vertically, ANT (+)/POS (−); NIF: head and foot direction horizontal movement, NIF (+)/SUP (−); LFT: left and right rotation, R (+)/L (−); H-UP: head up and down, head-up(+)/head-down(−); CCW: clockwise and counterclockwise directions, CW (+)/CCW (−). High-precision treatment of the spinal tumor could be achieved by robotic stereotactic radiotherapy.

Figure 3

Toxicity of Robotic Stereotactic Radiotherapy. The side effects and grading of each patient. Most of which were in grade 1–2. Only one patient had grade 3 esophagitis.