Newswise — Winner of the Sanford J. Larson, MD, PhD, Award, Shashank Gandhi, MD, presented his research, Kyphoplasty Intraoperative Radiation Therapy: A New Treatment Paradigm for Spinal Metastasis – Phase I/II Clinical Trial, during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Open surgery followed by stereotactic radiosurgery (SRS) is the standard of care for unstable spine metastasis. Post-radiation vertebral-compression-fractures (VCF) range from 11-39 percent. As radiation treatment is palliative due to systemic tumor burden, pain and quality of life improvement is paramount. Kyphoplasty intraoperative radiation therapy (Kypho-iORT) is a minimally invasive procedure to radiate metastasis from within vertebral bodies, preventing VCF while providing immediate pain relief in potentially unstable spines.
This study reports on a prospective phase I/II clinical trial to assess safety and efficacy of Kypho-iORT for potentially unstable spinal metastasis in improving pain and functional status and maintaining local control. Pain scores were assessed with the numeric pain rating scale (NPRS), functional status with brief pain inventory (BPI) and local control and VCF with CT/MRI.
Patients with symptomatic metastasis underwent intraoperative electron-accelerated radiation followed by kyphoplasty. Tumors were limited to vertebral body with SINS scores 7-12. Eighteen levels in 13 patients were treated. No patients experienced neurological deterioration. NPRS scores decreased from preoperative and improved significantly out to 12 months. Functional status also improved significantly out to 12 months and narcotic use reduced in 8 of 13 patients. Only one patient had progression of disease requiring surgery.
Kypho-iORT is a safe option for potentially unstable spinal metastases. Pain and function significantly improve, enhancing quality of life, allowing patients to return to their daily activities and resume systemic treatment sooner. Local control and reduction in VCF can be obtained. Long-term follow-up is necessary to further evaluate efficacy.
Author Block: Ahmad Latefi, DO; Ferney Diaz Molina, MS; Maged Ghaly, MD
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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