Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine Journal Article


Authors: Folkert, M. R.; Bilsky, M. H.; Cohen, G. N.; Zaider, M.; Lis, E.; Krol, G.; Laufer, I.; Yamada, Y.
Article Title: Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine
Abstract: Purpose: Advances in stereotactic radiosurgery have improved local control of spine metastases, but local failure is still a problem and repeat irradiation is limited by normal tissue tolerance. A novel high-dose-rate (HDR) brachytherapy technique has been developed to treat these previously irradiated lesions. Methods and Materials: Five patients with progressive disease at previously irradiated sites in the spine who were not amenable to further external beam radiation were treated. Catheters were placed intraoperatively in 2 patients and percutaneously implanted in 3 patients with image-guided techniques. Conformal plans were generated to deliver dose to target tissues and spare critical structures. Patients received single-fraction treatment using HDR iridium-192 brachytherapy. Results: Median dose was 14 Gy (range, 12-18 Gy) with a median gross total volume D90 of 75% (range, 31-94%); spinal cord/cauda equina dose constraints were met. At a median followup of 9 months, no local progression of disease has been observed. Four patients had reduction in pain 1-4 weeks after treatment. No brachytherapy-related complications have been observed. Conclusions: Intraoperative and percutaneous iridium-192 HDR spine brachytherapy techniques were not associated with complications or acute toxicity. There has been no local progression at treated sites, and most patients experienced reduction in cancer-related pain. © 2013 American Brachytherapy Society.
Keywords: adult; clinical article; aged; cancer growth; treatment planning; radiation dose; nuclear magnetic resonance imaging; follow up; computer assisted tomography; cancer pain; radiation dose fractionation; spinal cord; spine; brachytherapy; stereotactic radiosurgery; external beam radiotherapy; metastases; computer assisted radiotherapy; analgesia; iridium 192; spine metastasis; fluoroscopy; catheter; recurrent; reirradiation; cauda equina; image guided radiotherapy; high-dose-rate
Journal Title: Brachytherapy
Volume: 12
Issue: 5
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2013-09-01
Start Page: 449
End Page: 456
Language: English
DOI: 10.1016/j.brachy.2013.01.162
PROVIDER: scopus
PUBMED: 23462536
DOI/URL:
Notes: --- - "Export Date: 1 October 2013" - "CODEN: BRACC" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Eric Lis
    104 Lis
  2. Yoshiya Yamada
    359 Yamada
  3. Mark H Bilsky
    223 Bilsky
  4. Michael Ryan Folkert
    36 Folkert
  5. Gilad N Cohen
    132 Cohen
  6. Marco Zaider
    169 Zaider
  7. George Krol
    33 Krol
  8. Ilya Laufer
    99 Laufer