First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

Abstract

Object: Based on previous studies, 30 to 40% of cancer patients are diagnosed with bone metastasis. Median Overall Survival (OS) of patients who are diagnosed with spinal metastasis (vertebral structures) is about 7 to 9 months which with recent progresses in oncologic and radiotherapy treatment modalities, their prognosis is slightly developed. In this study, authors plan to evaluate the effects of Intra-operative Radiation Therapy (IORT) in patients who are candidate for Kyphoplasty procedure. Methods: In this study, we have included patients who are diagnosed with spinal metastasis with radiological and histopathological confirmation. From July 2017 to December 2018, we have included 9 patients who fulfilled our predefined inclusion and exclusion criteria into our case-series study performed on Shohada Tajrish Hospital. Patients underwent radiotherapy during Kyphoplasty by our IORT device INTRABEAM (Carl Zeiss AG, Germany) as “Kypho-IORT’ procedure. We have evaluated these patients in post-operative period, as well as on 2 weeks, 1 month, 2 months and 6 months on post-operative period as our follow-up plan. Results: In this study, 9 patients (5 males and 4 females) with mean age of 68 years with spinal metastasis from breast (4 cases), prostate (2 cases), lung (2 cases) and gastrointestinal tract (1 case), underwent Kypho-IORT for 15 vertebrae levels with individualized radiation dose and interval. In postoperative follow-up period, patients exhibit pain relief (in 78%) assessed by Visual Assessment Score (VAS) and improvement in their Quality of Life (QoL). No major complications including new neurological deficit, major cement leak and embolic disorders were encountered during the study; however, minor cement leak encountered in 4 cases, and 2 patients have expired during follow up period; however, other patients are still alive and under follow-up with mean OS of 10 months. Conclusion: This study is the first experience of evaluation of IORT effects during Kyphoplasty in Iran, in patients diagnosed with spinal metastasis with poor prognosis, to improve their quality of life, local control rate and their OS. This study could be considered as one of the pioneers in continuing the evaluation of Kypho-IORT as a novel technique in these group of patients.