High-Dose Rate Interstitial Spine Brachytherapy Using an Intraoperative Mobile Computed Tomography-Guided Surgical Navigation System.

Autor:	Medina R; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA., Macyszyn L; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA., Lim AS; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Attiah M; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA., Kafka-Peterson K; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Kaprelian T; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Hegde JV; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Venkat P; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Lee A; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Park SJ; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Chang AJ; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2021 Nov 15; Vol. 21 (6), pp. 507-515.
DOI:	10.1093/ons/opab328
Abstrakt:	Background: Up to 15% of previously irradiated metastatic spine tumors will progress. Re-irradiation of these tumors poses a significant risk of exceeding the radiation tolerance to the spinal cord. High-dose rate (HDR) brachytherapy is a treatment alternative. Objective: To develop a novel HDR spine brachytherapy technique using an intraoperative computed tomography-guided navigation (iCT navigation). Methods: Patients with progressive metastatic spine tumors were included in the study. HDR brachytherapy catheters were placed under iCT navigation. CT-based planning with magnetic resonance imaging fusion was performed to ensure conformal dose delivery to the target while sparing normal tissue, including the spinal cord. Patients received single fraction radiation treatment. Results: Five patients with thoracolumbar tumors were treated with HDR brachytherapy. Four patients previously received radiotherapy to the same spinal level. Preimplant plans demonstrated median clinical target volume (CTV) D90 of 116.5% (110.8%-147.7%), V100 of 95.7% (95.5%-99.6%), and Dmax of 8.08 Gy (7.65-9.8 Gy) to the spinal cord/cauda equina. Postimplant plans provided median CTV D90 of 113.8% (93.6%-120.1%), V100 of 95.9% (87%-99%), and Dmax of 9.48 Gy (6.5-10.3 Gy) to cord/cauda equina. Patients who presented with back pain (n = 3) noted symptomatic improvement at a median follow-up of 22 d after treatment. Four patients demonstrated local tumor control of spinal metastatic tumor at a median follow-up of 92 d after treatment. One patient demonstrated radiographic evidence of local tumor progression 2.7 mo after treatment. Conclusion: HDR spine brachytherapy with iCT navigation is a promising treatment alternative to induce local tumor control and reduce pain symptoms associated with metastatic spine disease. (© Congress of Neurological Surgeons 2021.)
Databáze:	MEDLINE
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