Abstract Background Instable and painful vertebral metastases in patients with progressive visceral metastases present a common therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT) during kyphoplasty and report the first treated case. Methods/Results 60 year old patient with metastasizing breast cancer under chemotherapy presented with a newly diagnosed painful metastasis in the 12th thoracic vertebra. Under general anaesthesia, a bipedicular approach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electron drift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This was inserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mm distance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated after IORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes. Conclusion In conclusion, this novel, minimally invasive procedure can be performed in standard operating rooms and may become a valuable option for patients with vertebral metastases providing immediate stability and local control. A phase I/II study is under way to establish the optimal dose prescription.</p

Christian Neumaier

D Rades

DF Kallmes

DM Sciubba

ER Cardoso

Frank Schneider

Frederik Wenz

GR Cosgrove

J Wong

JS Jang

JS Vaidya

O Ofluoglu

PC Gerszten

R Buchbinder

R Souchon

René Schmidt

RT Hoffmann

Tina Reis

U Kraus-Tiefenbacher

Udo Obertacke

Uta Kraus-Tiefenbacher

English

PubMed

Abstract Background Instable and painful vertebral metastases in patients with progressive visceral metastases present a common therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT) during kyphoplasty and report the first treated case. Methods/Results 60 year old patient with metastasizing breast cancer under chemotherapy presented with a newly diagnosed painful metastasis in the 12th thoracic vertebra. Under general anaesthesia, a bipedicular approach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electron drift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This was inserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mm distance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated after IORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes. Conclusion In conclusion, this novel, minimally invasive procedure can be performed in standard operating rooms and may become a valuable option for patients with vertebral metastases providing immediate stability and local control. A phase I/II study is under way to establish the optimal dose prescription.</p

Schmidt René

Reis Tina

Kraus-Tiefenbacher Uta

Neumaier Christian

Schneider Frank

Wenz Frederik

Obertacke Udo

Directory of Open Access Journals

Radiation Oncology

Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases

Frederik  Wenz

Crossref

METHODOLOGY Open AccessKypho-IORT - a novel approach of intraoperativeradiotherapy during kyphoplasty for vertebralmetastasesFrederik Wenz1*, Frank Schneider1, Christian Neumaier1, Uta Kraus-Tiefenbacher1, Tina Reis1, René Schmidt2,Udo Obertacke2AbstractBackground: Instable and painful vertebral metastases in patients with progressive visceral metastases present acommon therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT)during kyphoplasty and report the first treated case.Methods/Results: 60 year old patient with metastasizing breast cancer under chemotherapy presented with anewly diagnosed painful metastasis in the 12th thoracic vertebra. Under general anaesthesia, a bipedicularapproach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electrondrift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This wasinserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mmdistance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated afterIORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes.Conclusion: In conclusion, this novel, minimally invasive procedure can be performed in standard operating roomsand may become a valuable option for patients with vertebral metastases providing immediate stability and localcontrol. A phase I/II study is under way to establish the optimal dose prescription.BackgroundIt is a common therapeutic dilemma in the treatment ofadvanced stage cancer that progressive visceral metas-tases and instable and painful bone metastases are pre-sent simultaneously and require urgent treatment.However, due to potentiated toxicity, simultaneoustreatment with full dose chemotherapy and fractionatedradiotherapy is rarely possible. In addition, instability ofthe vertebral column may require prolonged periods ofbed rest. We have therefore developed a novel approachto deliver intraoperative radiotherapy (IORT) duringkyphoplasty in order to regain immediate stability, steri-lize the metastasis and continue with chemotherapywithout a delay of several weeks. Here we report aboutthe first use of this novel approach (Kypho-IORT).ResultsA 60 year old patient with metastasizing breast cancerto the lung and mediastinal lymph nodes under doce-taxel chemotherapy (75 mg/sqm q21d for 3 cycles) pre-sented with a newly diagnosed painful metastasis in the12th thoracic vertebra. There was an increased risk for apathologic fracture due to the extent of the vertebralmetastasis (see figure 1). The initial diagnosis of a recep-tor-positive lobular-invasive breast cancer (pT2 pN1aG2 her2neu FISH negative) in the left upper-outerquadrant was made 3 years ago. The patient receivedinitially breast conserving surgery, axillary dissection,adjuvant chemotherapy (6 × FEC) and whole breastradiotherapy with boost (50 + 16 Gy) followed by endo-crine therapy using letrozole. Visceral metastases werediagnosed three months ago during routine follow-upand palliative chemotherapy was initiated.The kyphoplasty itself was performed according to thestandard procedure with some minor modifications. Inshort, under general anaesthesia and after sterile* Correspondence: frederik.wenz@umm.de1Department of Radiation Oncology, University Medical Centre Mannheim,Heidelberg University, Mannheim, GermanyWenz et al. Radiation Oncology 2010, 5:11http://www.ro-journal.com/content/5/1/11© 2010 Wenz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.preparation of the patient, a bipedicular approach waschosen (see figure 2). Specially designed metallic sleeves(5 mm diameter, 6 cm length) were inserted (see figure3) to guide the electron drift tube (3.2 mm diameter) ofthe miniature X-ray generator (INTRABEAM, Carl ZeissSurgical, Oberkochen, Germany). After verification ofthe position of the guiding sleeves using biplanar X-ray,the INTRABEAM system was inserted with a novelsheet (diameter 4.2 mm) designed for this approach pro-tecting the drift tube (see figure 4 + 5). Special care wastaken to avoid sheer and bending stress on the drifttube and the sheet. A radiation dose of 8 Gy in 5 mmdistance (50 kV X-rays, corresponding to 27 Gy at 2mm distance from surface of the radiation source) wasdelivered during about 90 seconds to the center of themetastasis. Examples of dose distributions depending onthe position of the radiation source can be seen in fig-ures 6 + 7. Afterwards, the INTRABEAM system wasremoved. The kyphoplasty balloons (KyphX, KyphonInc, Sunnyvale) were inflated with 300 PSI on eitherside and 2 × 4 ml polymethylmethacrylate (PMMA)cement were injected (KyphX, Kyphon Inc, Sunnyvale,see figure 8). The guiding sleeves were extracted andskin closure was done as usual. The whole procedurelasted less than 90 minutes. The patient was pain freeon the day following the procedure and there was novisible radiation induced skin reaction.DiscussionPercutaneous kyphoplasty and vertebroplasty areincreasingly used [1-5]. It is a valuable treatment optionfor patients with painful and instable metastases to thevertebral column although its value for osteoporoticfractures has been recently questioned [6,7]. Now it ispossible to combine this procedure with the delivery ofa high dose of intraoperative radiotherapy (IORT) pro-viding immediate stability, pain relief and sterilization ofthe metastasis. Technically, vertebrae below the level ofthoracic vertebra 3 are suitable for the Kypho-IORTapproach when the metastasis is predominantly locatedin the vertebral body. A limited destruction of the dorsalcorticalis is not a contraindication, however, specialattention should be paid to avoid leakage of the PMMAFigure 1 Coronal CT scan of the vertebral metastasis.Figure 2 Specially designed guiding sleeves were insertedusing a bipendicular approach.Figure 3 X-ray control of guiding sleeve position.Wenz et al. Radiation Oncology 2010, 5:11http://www.ro-journal.com/content/5/1/11Page 2 of 4into the spinal canal ("egg-shell technique”). Whethermetastases in the pedicle can be approached with thistechnique remains to be determined based on the doseto the spinal cord and the stability of the positioning ofthe IORT device. External beam radiotherapy or radio-surgery [8,9] even when combined with bisphosphonatesdo provide improved structural stability only after a pro-longed period of time and the hazards of open radionu-clides are avoided with this X-ray based approach [10].A detailed discussion about different fractionation sche-dules for the treatment of spinal cord metastases can befound in a recent review [11]. This new applicationbroadens the potential applications of the Intrabeamsystem, which is up to now mainly used for IORT forFigure 5 The INTRABEAM system in treatment position.Figure 6 Dose distribution for localization in the center of thevertebra. Please note that the spinal cord is touched by the 1 Gyisodose.Figure 7 The 8 Gy isodose reaches the spinal cord afterplacement of the radiation source in the dorsal part of thevertebra.Figure 4 The INTRABEAM system is inserted into the guidingsleeves while the drift tube is protected by a novel sheet.Wenz et al. Radiation Oncology 2010, 5:11http://www.ro-journal.com/content/5/1/11Page 3 of 4breast cancer [12-14], and brain tumors [15]. Becauselong term experiences with this approach are not avail-able at present, a phase I/II study is ongoing to establishthe optimal dose presciption to provide local control.ConclusionIORT with low energy X-rays can be performed duringkyphoplasty in standard operating rooms without thenecessity of excessive radiation protection measures. Assurvival times of patients with many types of advancedcancer increase, the demand for this novel approach willpotentially increase in the future.Author details1Department of Radiation Oncology, University Medical Centre Mannheim,Heidelberg University, Mannheim, Germany. 2Department for Orthopaedicsand Trauma Surgery, University Medical Centre Mannheim, HeidelbergUniversity, Mannheim, Germany.Authors’ contributionsFW, UO, FS: idea and concept; FW, FS, UKT, RS, UO: design anddevelopment; CN, UKT, TR, RS: patient selection and care; FW, CN, TR: writingof manuscript; FW, FS, CN, UKT, TR, RS; UO: final revision of manuscript. Allauthors have read and approved the final manuscript.Competing interestsCarl Zeiss Surgical Oberkochen supports radiobiological research atUniversity Medical Centre Mannheim.Received: 3 December 2009Accepted: 11 February 2010 Published: 11 February 2010References1. Hoffmann RT, Jakobs TF, Wallnöfer A, et al: Percutaneous vertebroplasty(PV): indications, contraindications, and technique. Radiologe 2003,43(9):709-717.2. Jang JS, Lee SH: Efficacy of percutaneous vertebroplasty combined withradiotherapy in osteolytic metastatic spinal tumors. J Neurosurg Spine2005, 2(3):243-248.3. Ofluoglu O: Minimally invasive management of spinal metastases. OrthopClin North Am 2009, 40(1):155-168.4. Sciubba DM, Nguyen T, Gokaslan ZL: Solitary vertebral metastsis. OrthopClin North Am 2009, 40(1):145-154.5. Wong J, Chow E, de Sa E, et al: Immediate pain relief and improvedstructural stability after percutaneous vertebroplasty for a severelydestructive vertebral compression fracture. J Palliat Med 2009,12(1):97-100.6. Buchbinder R, Osborne RH, Ebeling PR, et al: A randomized trial ofvertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med2009, 361:557-568.7. Kallmes DF, Comstock BA, Heagerty PJ, et al: A randomized trial ofvertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009,361:569-579.8. Gerszten PC, Welch WC: Cyberknife radiosurgery for metastatic spinetumors. Neurosurg Clin N Am 2004, 15(4):491-501.9. Rades D, Veninga T, Stalpers LJ, et al: Outcome after radiotherapy alonefor metastatic spinal cors comporession in patients witholigometastases. J Clin Oncol 2007, 25(1):50-56.10. Cardoso ER, Ashamalla H, Weng L, et al: Percutaneous tumor curretageand interstitial delivery of samarium-153 coupled with kyphoplasty fortreatment of vertebral metastases. J Neurosurg Spine 2009, 10(4):336-342.11. Souchon R, Wenz F, Sedlmayer F, et al: DEGRO practice guidelines forpalliative radiotherapy of metastatic breast cancer: bone metastases andmetastatic spinal cord compression (MSCC). Strahlenther Onkol 2009,185(7):417-424.12. Vaidya JS, Baum M, D’Souza DP, et al: Targeted intra-operativeradiotherapy (Targit): an innovative method of treatment for early breastcancer. Ann Oncol 2001, 12(8):1075-1080.13. Vaidya JS, Hall-Craggs M, Baum M, et al: Percutaneous minimally invasivestereotactic primary radiotherapy for breast cancer. Lancet Oncol 2002,3(4):252-253.14. Kraus-Tiefenbacher U, Steil V, Bauer L, Melchert F, Wenz F: A novel devicefor intraoperative radiotherapy (IORT). Onkologie 2003, 26:596-598.15. Cosgrove GR, Hochberg FH, Zervas NT, et al: Interstitial irradiation of braintumors, using a miniature radiosurgery device: initial experience.Neurosurgery 1997, 40(3):518-523.doi:10.1186/1748-717X-5-11Cite this article as: Wenz et al.: Kypho-IORT - a novel approach ofintraoperative radiotherapy during kyphoplasty for vertebralmetastases. Radiation Oncology 2010 5:11.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitFigure 8 PMMA cement is injected after inflation of thekyphoplasty balloons to stabilize the vertebra.Wenz et al. Radiation Oncology 2010, 5:11http://www.ro-journal.com/content/5/1/11Page 4 of 4

Springer - Publisher Connector

METHODOLOGY Open Access
Kypho-IORT - a novel approach of intraoperative
radiotherapy during kyphoplasty for vertebral
metastases
Frederik Wenz1*, Frank Schneider1, Christian Neumaier1, Uta Kraus-Tiefenbacher1, Tina Reis1, René Schmidt2,
Udo Obertacke2
Abstract
Background: Instable and painful vertebral metastases in patients with progressive visceral metastases present a
common therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT)
during kyphoplasty and report the first treated case.
Methods/Results: 60 year old patient with metastasizing breast cancer under chemotherapy presented with a
newly diagnosed painful metastasis in the 12th thoracic vertebra. Under general anaesthesia, a bipedicular
approach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electron
drift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This was
inserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mm
distance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated after
IORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes.
Conclusion: In conclusion, this novel, minimally invasive procedure can be performed in standard operating rooms
and may become a valuable option for patients with vertebral metastases providing immediate stability and local
control. A phase I/II study is under way to establish the optimal dose prescription.
Background
It is a common therapeutic dilemma in the treatment of
advanced stage cancer that progressive visceral metas-
tases and instable and painful bone metastases are pre-
sent simultaneously and require urgent treatment.
However, due to potentiated toxicity, simultaneous
treatment with full dose chemotherapy and fractionated
radiotherapy is rarely possible. In addition, instability of
the vertebral column may require prolonged periods of
bed rest. We have therefore developed a novel approach
to deliver intraoperative radiotherapy (IORT) during
kyphoplasty in order to regain immediate stability, steri-
lize the metastasis and continue with chemotherapy
without a delay of several weeks. Here we report about
the first use of this novel approach (Kypho-IORT).
Results
A 60 year old patient with metastasizing breast cancer
to the lung and mediastinal lymph nodes under doce-
taxel chemotherapy (75 mg/sqm q21d for 3 cycles) pre-
sented with a newly diagnosed painful metastasis in the
12th thoracic vertebra. There was an increased risk for a
pathologic fracture due to the extent of the vertebral
metastasis (see figure 1). The initial diagnosis of a recep-
tor-positive lobular-invasive breast cancer (pT2 pN1a
G2 her2neu FISH negative) in the left upper-outer
quadrant was made 3 years ago. The patient received
initially breast conserving surgery, axillary dissection,
adjuvant chemotherapy (6 × FEC) and whole breast
radiotherapy with boost (50 + 16 Gy) followed by endo-
crine therapy using letrozole. Visceral metastases were
diagnosed three months ago during routine follow-up
and palliative chemotherapy was initiated.
The kyphoplasty itself was performed according to the
standard procedure with some minor modifications. In
short, under general anaesthesia and after sterile
* Correspondence: frederik.wenz@umm.de
1Department of Radiation Oncology, University Medical Centre Mannheim,
Heidelberg University, Mannheim, Germany
Wenz et al. Radiation Oncology 2010, 5:11
http://www.ro-journal.com/content/5/1/11
© 2010 Wenz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
preparation of the patient, a bipedicular approach was
chosen (see figure 2). Specially designed metallic sleeves
(5 mm diameter, 6 cm length) were inserted (see figure
3) to guide the electron drift tube (3.2 mm diameter) of
the miniature X-ray generator (INTRABEAM, Carl Zeiss
Surgical, Oberkochen, Germany). After verification of
the position of the guiding sleeves using biplanar X-ray,
the INTRABEAM system was inserted with a novel
sheet (diameter 4.2 mm) designed for this approach pro-
tecting the drift tube (see figure 4 + 5). Special care was
taken to avoid sheer and bending stress on the drift
tube and the sheet. A radiation dose of 8 Gy in 5 mm
distance (50 kV X-rays, corresponding to 27 Gy at 2
mm distance from surface of the radiation source) was
delivered during about 90 seconds to the center of the
metastasis. Examples of dose distributions depending on
the position of the radiation source can be seen in fig-
ures 6 + 7. Afterwards, the INTRABEAM system was
removed. The kyphoplasty balloons (KyphX, Kyphon
Inc, Sunnyvale) were inflated with 300 PSI on either
side and 2 × 4 ml polymethylmethacrylate (PMMA)
cement were injected (KyphX, Kyphon Inc, Sunnyvale,
see figure 8). The guiding sleeves were extracted and
skin closure was done as usual. The whole procedure
lasted less than 90 minutes. The patient was pain free
on the day following the procedure and there was no
visible radiation induced skin reaction.
Discussion
Percutaneous kyphoplasty and vertebroplasty are
increasingly used [1-5]. It is a valuable treatment option
for patients with painful and instable metastases to the
vertebral column although its value for osteoporotic
fractures has been recently questioned [6,7]. Now it is
possible to combine this procedure with the delivery of
a high dose of intraoperative radiotherapy (IORT) pro-
viding immediate stability, pain relief and sterilization of
the metastasis. Technically, vertebrae below the level of
thoracic vertebra 3 are suitable for the Kypho-IORT
approach when the metastasis is predominantly located
in the vertebral body. A limited destruction of the dorsal
corticalis is not a contraindication, however, special
attention should be paid to avoid leakage of the PMMA
Figure 1 Coronal CT scan of the vertebral metastasis.
Figure 2 Specially designed guiding sleeves were inserted
using a bipendicular approach.
Figure 3 X-ray control of guiding sleeve position.
Wenz et al. Radiation Oncology 2010, 5:11
http://www.ro-journal.com/content/5/1/11
Page 2 of 4
into the spinal canal ("egg-shell technique”). Whether
metastases in the pedicle can be approached with this
technique remains to be determined based on the dose
to the spinal cord and the stability of the positioning of
the IORT device. External beam radiotherapy or radio-
surgery [8,9] even when combined with bisphosphonates
do provide improved structural stability only after a pro-
longed period of time and the hazards of open radionu-
clides are avoided with this X-ray based approach [10].
A detailed discussion about different fractionation sche-
dules for the treatment of spinal cord metastases can be
found in a recent review [11]. This new application
broadens the potential applications of the Intrabeam
system, which is up to now mainly used for IORT for
Figure 5 The INTRABEAM system in treatment position.
Figure 6 Dose distribution for localization in the center of the
vertebra. Please note that the spinal cord is touched by the 1 Gy
isodose.
Figure 7 The 8 Gy isodose reaches the spinal cord after
placement of the radiation source in the dorsal part of the
vertebra.
Figure 4 The INTRABEAM system is inserted into the guiding
sleeves while the drift tube is protected by a novel sheet.
Wenz et al. Radiation Oncology 2010, 5:11
http://www.ro-journal.com/content/5/1/11
Page 3 of 4
breast cancer [12-14], and brain tumors [15]. Because
long term experiences with this approach are not avail-
able at present, a phase I/II study is ongoing to establish
the optimal dose presciption to provide local control.
Conclusion
IORT with low energy X-rays can be performed during
kyphoplasty in standard operating rooms without the
necessity of excessive radiation protection measures. As
survival times of patients with many types of advanced
cancer increase, the demand for this novel approach will
potentially increase in the future.
Author details
1Department of Radiation Oncology, University Medical Centre Mannheim,
Heidelberg University, Mannheim, Germany. 2Department for Orthopaedics
and Trauma Surgery, University Medical Centre Mannheim, Heidelberg
University, Mannheim, Germany.
Authors’ contributions
FW, UO, FS: idea and concept; FW, FS, UKT, RS, UO: design and
development; CN, UKT, TR, RS: patient selection and care; FW, CN, TR: writing
of manuscript; FW, FS, CN, UKT, TR, RS; UO: final revision of manuscript. All
authors have read and approved the final manuscript.
Competing interests
Carl Zeiss Surgical Oberkochen supports radiobiological research at
University Medical Centre Mannheim.
Received: 3 December 2009
Accepted: 11 February 2010 Published: 11 February 2010
References
1. Hoffmann RT, Jakobs TF, Wallnöfer A, et al: Percutaneous vertebroplasty
(PV): indications, contraindications, and technique. Radiologe 2003,
43(9):709-717.
2. Jang JS, Lee SH: Efficacy of percutaneous vertebroplasty combined with
radiotherapy in osteolytic metastatic spinal tumors. J Neurosurg Spine
2005, 2(3):243-248.
3. Ofluoglu O: Minimally invasive management of spinal metastases. Orthop
Clin North Am 2009, 40(1):155-168.
4. Sciubba DM, Nguyen T, Gokaslan ZL: Solitary vertebral metastsis. Orthop
Clin North Am 2009, 40(1):145-154.
5. Wong J, Chow E, de Sa E, et al: Immediate pain relief and improved
structural stability after percutaneous vertebroplasty for a severely
destructive vertebral compression fracture. J Palliat Med 2009,
12(1):97-100.
6. Buchbinder R, Osborne RH, Ebeling PR, et al: A randomized trial of
vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med
2009, 361:557-568.
7. Kallmes DF, Comstock BA, Heagerty PJ, et al: A randomized trial of
vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009,
361:569-579.
8. Gerszten PC, Welch WC: Cyberknife radiosurgery for metastatic spine
tumors. Neurosurg Clin N Am 2004, 15(4):491-501.
9. Rades D, Veninga T, Stalpers LJ, et al: Outcome after radiotherapy alone
for metastatic spinal cors comporession in patients with
oligometastases. J Clin Oncol 2007, 25(1):50-56.
10. Cardoso ER, Ashamalla H, Weng L, et al: Percutaneous tumor curretage
and interstitial delivery of samarium-153 coupled with kyphoplasty for
treatment of vertebral metastases. J Neurosurg Spine 2009, 10(4):336-342.
11. Souchon R, Wenz F, Sedlmayer F, et al: DEGRO practice guidelines for
palliative radiotherapy of metastatic breast cancer: bone metastases and
metastatic spinal cord compression (MSCC). Strahlenther Onkol 2009,
185(7):417-424.
12. Vaidya JS, Baum M, D’Souza DP, et al: Targeted intra-operative
radiotherapy (Targit): an innovative method of treatment for early breast
cancer. Ann Oncol 2001, 12(8):1075-1080.
13. Vaidya JS, Hall-Craggs M, Baum M, et al: Percutaneous minimally invasive
stereotactic primary radiotherapy for breast cancer. Lancet Oncol 2002,
3(4):252-253.
14. Kraus-Tiefenbacher U, Steil V, Bauer L, Melchert F, Wenz F: A novel device
for intraoperative radiotherapy (IORT). Onkologie 2003, 26:596-598.
15. Cosgrove GR, Hochberg FH, Zervas NT, et al: Interstitial irradiation of brain
tumors, using a miniature radiosurgery device: initial experience.
Neurosurgery 1997, 40(3):518-523.
doi:10.1186/1748-717X-5-11
Cite this article as: Wenz et al.: Kypho-IORT - a novel approach of
intraoperative radiotherapy during kyphoplasty for vertebral
metastases. Radiation Oncology 2010 5:11.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Figure 8 PMMA cement is injected after inflation of the
kyphoplasty balloons to stabilize the vertebra.
Wenz et al. Radiation Oncology 2010, 5:11
http://www.ro-journal.com/content/5/1/11
Page 4 of 4


A randomized trial of vertebroplasty for osteoporotic spinal fractures.

A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.

al: Percutaneous tumor curretage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases.

DEGRO practice guidelines for palliative radiotherapy of metastatic breast cancer: bone metastases and metastatic spinal cord compression (MSCC). Strahlenther Onkol

et al: Immediate pain relief and improved structural stability after percutaneous vertebroplasty for a severely destructive vertebral compression fracture.

et al: Percutaneous vertebroplasty (PV): indications, contraindications, and technique. Radiologe

F: A novel device for intraoperative radiotherapy (IORT). Onkologie

Gokaslan ZL: Solitary vertebral metastsis. Orthop Clin North Am

Interstitial irradiation of brain tumors, using a miniature radiosurgery device: initial experience. Neurosurgery

Minimally invasive management of spinal metastases. Orthop Clin North Am

Outcome after radiotherapy alone for metastatic spinal cors comporession in patients with oligometastases.

Percutaneous minimally invasive stereotactic primary radiotherapy for breast cancer. Lancet Oncol

SH: Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors.

Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol

WC: Cyberknife radiosurgery for metastatic spine tumors.

file:///data/core-remote/dit/data/Springer-OA/pdf/833/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTc0OC03MTdYLTUtMTEucGRm.pdf

Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

Crossref

Springer - Publisher Connector