The First Experience in the Intraoperative Radiotherapy with Simultaneous Vertebroplasty (VP-IORT) under Ccbct in a Patient with Vertebral Metastases

Technique

Mironova Y.A., Dubskikh A.O., Tarkhanov A.A., Bayankin S.N., Bentsion D.L., 
Chudinovskikh V.A., Gerasimov M.V., Kartashov M.V.

Abstract.
Spine metastatic lesion is a common problem in palliative oncology. Using the experience of foreign colleagues, we applied a new approach of a combined treatment of a patient with spinal metastases. Purpose: Assessment of the possibility of intraoperative brachytherapy with simultaneous vertebroplasty in case of spinal metastases under C-arm CBCT, Materials and Methods: A patient with CRC metastases in vertebrae L3, L4 has subjected to intraoperative radiotherapy with simultaneous vertebroplasty.
In to the corpus of vertebra L3 were installed 2 metal applicator for brachytherapy through metal puncture needles double in a sided transpedicular position. After CCBCT-control of the needle position and dosimetric planning, one session of irradiation by apparatus «GammaMed plus» (high dose rate) was made. The irradiation dose at the periphery of the vertebral corpus was 8 Gy. The irradiation dose in the spinal cord did not exceed 5 Gy. Later polymethylmethacrylate cement was implanted in to the vertebral corpus. To control the spread of the cementitious material in the vertebral corpus CCBCT was repeated. The total procedure took about 90 minutes. As a result the next day and after 1 (one) month-(the control) the patient had no pain syndrome, no neurological deficits, no acute irradiation reaction, no complications.
Conclusion: Simultaneous use of intraoperative brachytherapy and vertebroplasty in case of spinal metastatic lesions allows surgical and radiotherapeutic treatment in a short space time period. It solves the problem of pain syndrome neurologic disturbance. CCBCT allows to estimate the adequacy of installation of a irradiation source into a vertebra body. Introduction of their technique in to practice of the neurooncological service GBUZ SO «SOOD» is planned.

Key words:
spinal metastases, vertebroplasty, brachytherapy, CCBCT.

Authors:
Mironova Yulia A.
Dubskikh Alexey O.
Tarkhanov Andrey A
Bayankin Sergey N.
Bentsion Dmitry L.
Chudinovskikh Valentina A.
Gerasimov Maxim V.
Kartashov Maxim V.

Dispensary of Oncology, Sverdlovsk Region, Yekaterinbyrg. Russia