Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: A clinical and dosimetric analysis Journal Article


Authors: Barzilai, O.; DiStefano, N.; Lis, E.; Yamada, Y.; Lovelock, D. M.; Fontanella, A. N.; Bilsky, M. H.; Laufer, I.
Article Title: Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: A clinical and dosimetric analysis
Abstract: OBJECTIVE The aim of this study was to evaluate the safety and effcacy of kyphoplasty treatment prior to spine stereotactic radiosurgery (SRS) in patients with spine metastases. METHODS A retrospective review of charts, radiology reports, and images was performed for all patients who received SRS (single fraction either standalone or post-kyphoplasty) at a large tertiary cancer center between January 2012 and July 2015. Patient and tumor variables were documented, as well as treatment planning data and dosimetry. To measure the photon scatter due to polymethyl methacrylate, megavolt photon beam attenuation was determined experimentally as it passed through a kyphoplasty cement phantom. Corrected electron density values were recalculated and compared with uncorrected values. RESULTS Of 192 treatment levels in 164 unique patients who underwent single-fraction SRS, 17 (8.8%) were treated with kyphoplasty prior to radiation delivery to the index level. The median time from kyphoplasty to SRS was 22 days. Four of 192 treatments (2%) demonstrated local tumor recurrence or progression at the time of analysis. Of the 4 local failures, 1 patient had kyphoplasty prior to SRS. This recurrence occurred 18 months after SRS in the setting of widespread systemic disease and spinal tumor progression. Dosimetric review demonstrated a lower than average treatment dose for this case compared with the rest of the cohort. There were no signifcant differences in dosimetry analysis between the group of patients who underwent kyphoplasty prior to SRS and the remaining patients in the cohort. A preliminary analysis of polymethyl methacrylate showed that dosimetric errors due to uncorrected electron density values were insignifcant. CONCLUSIONS In cases without epidural spinal cord compression, stabilization with cement augmentation prior to SRS is safe and does not alter the effcacy of the radiation or preclude physicians from adhering to SRS planning and contouring guidelines. © AANS 2018, except where prohibited by US copyright law.
Keywords: adult; aged; major clinical study; cancer recurrence; cancer growth; nuclear magnetic resonance imaging; follow up; cohort analysis; medical record review; oncology; retrospective study; bone lesion; dosimetry; spinal cord compression; local control; stereotactic radiosurgery; spine metastasis; kyphoplasty; light scattering; myelography; poly(methyl methacrylate); compression fracture; organs at risk; spine tumors; human; male; female; article; spine srs
Journal Title: Journal of Neurosurgery: Spine
Volume: 28
Issue: 1
ISSN: 1547-5654
Publisher: American Association of Neurological Surgeons  
Date Published: 2018-01-01
Start Page: 72
End Page: 78
Language: English
DOI: 10.3171/2017.5.spine1746
PROVIDER: scopus
PUBMED: 29087812
PMCID: PMC8274655
DOI/URL:
Notes: Article -- Export Date: 1 February 2018 -- Source: Scopus
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MSK Authors
  1. Eric Lis
    130 Lis
  2. Yoshiya Yamada
    453 Yamada
  3. Mark H Bilsky
    303 Bilsky
  4. Dale M Lovelock
    181 Lovelock
  5. Ilya Laufer
    144 Laufer