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Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC.

Li Y, Qing Y, Zhang Z, Li M, Xie J, Wang G, Wang D - Onco Targets Ther (2015)

Bottom Line: Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure.The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05).Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China ; Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, People's Republic of China.

ABSTRACT

Objective: This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) combined with intensity-modulated radiotherapy (IMRT) for metastatic lesions of patients with non-small-cell lung cancer (NSCLC) at centrum vertebrae.

Methods: A total of 39 patients with spinal metastatic NSCLC (stage IV) were treated with PVP followed by IMRT (30 Gy/10F/2 W) for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS), activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline) at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group.

Results: A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05). Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05). No severe complications were observed. Mild complications included two cases (5.13%) of asymptomatic cement leakage into the epidural space and one case (2.56%) of paravertebral leakage. Median survival time was extended to 13 months.

Conclusion: The safety and efficacy of PVP combined with IMRT in patients with NSCLC with metastatic lesions at centrum vertebrae and the ability to prevent the diseased vertebrae from further deformation and tumor infiltration into the vertebral body were demonstrated. PVP combined with IMRT should be the optimal technique for treatment of vertebral compression pain resulting from spinal metastatic NSCLC.

No MeSH data available.


Related in: MedlinePlus

PVP using a CT-guided translateral approach via the space between the carotid sheath and vertebral artery in a patient with NSCLC with metastasis to C2.Notes: (A) MRI demonstrates the osteolytic metastasis in C2 before PVP treatment. (B) The location of metastasis before PVP. (C) The needle tip was positioned as near as possible to anterior margin of vertebral body using CT-guided. translateral approach. (D) The tip is advanced toward the osteolytic portion of the targeted cervical spine. (E) The distribution of the cement after completion of the procedure. (F) MRI demonstrates the osteolytic metastasis in C2 has disappeared after 6 months with combined PVP and IMRT treatment.Abbreviations: CT, computed tomography; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; NSCLC, non-small-cell lung cancer; PVP, percutaneous vertebroplasty.
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f2-ott-8-2139: PVP using a CT-guided translateral approach via the space between the carotid sheath and vertebral artery in a patient with NSCLC with metastasis to C2.Notes: (A) MRI demonstrates the osteolytic metastasis in C2 before PVP treatment. (B) The location of metastasis before PVP. (C) The needle tip was positioned as near as possible to anterior margin of vertebral body using CT-guided. translateral approach. (D) The tip is advanced toward the osteolytic portion of the targeted cervical spine. (E) The distribution of the cement after completion of the procedure. (F) MRI demonstrates the osteolytic metastasis in C2 has disappeared after 6 months with combined PVP and IMRT treatment.Abbreviations: CT, computed tomography; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; NSCLC, non-small-cell lung cancer; PVP, percutaneous vertebroplasty.

Mentions: PVP was performed as mentioned elsewhere.11 Briefly, PVP was performed with a digital subtraction angiography unit with a C-arm (Angiostar, Siemens) in the neurointerventional angiography suite. Anatomic landmarks and structures differ according to the vertebral level. Depending on the site of the lesion in the thoracic and lumbar regions, four different approaches were possible: the transpedicular approach, with reliance on vertebral pedicles as landmarks; the posterolateral approach, which was initiated at a point. Unilateral transpedicular approach was used in most of patients. The metastatic area was sterilized, and local anesthesia of the skin and soft tissues was achieved by injecting 3 mL of 1% lidocaine. The needle tip was positioned as near to anterior margin of vertebral body as possible. The cement injection process was continuously monitored under fluoroscopic control in the lateral plane. Approximately 0.5 mL of prepared bone cement (approximately 20 g PMMA powder mixed with 10 mL monomer until suitable for injection) was then injected prior to scanning. Cement injection was terminated when the PMMA reached the posterior margin of the vertebral body. Immediately, a three-dimensional CT scan was then performed to determine the distribution of the cement after withdrawal of the needle and completion of the PVP (Figures 1 and 2). Antibiotics were administered 1 day before and for 2 days after the procedure.


Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC.

Li Y, Qing Y, Zhang Z, Li M, Xie J, Wang G, Wang D - Onco Targets Ther (2015)

PVP using a CT-guided translateral approach via the space between the carotid sheath and vertebral artery in a patient with NSCLC with metastasis to C2.Notes: (A) MRI demonstrates the osteolytic metastasis in C2 before PVP treatment. (B) The location of metastasis before PVP. (C) The needle tip was positioned as near as possible to anterior margin of vertebral body using CT-guided. translateral approach. (D) The tip is advanced toward the osteolytic portion of the targeted cervical spine. (E) The distribution of the cement after completion of the procedure. (F) MRI demonstrates the osteolytic metastasis in C2 has disappeared after 6 months with combined PVP and IMRT treatment.Abbreviations: CT, computed tomography; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; NSCLC, non-small-cell lung cancer; PVP, percutaneous vertebroplasty.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548765&req=5

f2-ott-8-2139: PVP using a CT-guided translateral approach via the space between the carotid sheath and vertebral artery in a patient with NSCLC with metastasis to C2.Notes: (A) MRI demonstrates the osteolytic metastasis in C2 before PVP treatment. (B) The location of metastasis before PVP. (C) The needle tip was positioned as near as possible to anterior margin of vertebral body using CT-guided. translateral approach. (D) The tip is advanced toward the osteolytic portion of the targeted cervical spine. (E) The distribution of the cement after completion of the procedure. (F) MRI demonstrates the osteolytic metastasis in C2 has disappeared after 6 months with combined PVP and IMRT treatment.Abbreviations: CT, computed tomography; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; NSCLC, non-small-cell lung cancer; PVP, percutaneous vertebroplasty.
Mentions: PVP was performed as mentioned elsewhere.11 Briefly, PVP was performed with a digital subtraction angiography unit with a C-arm (Angiostar, Siemens) in the neurointerventional angiography suite. Anatomic landmarks and structures differ according to the vertebral level. Depending on the site of the lesion in the thoracic and lumbar regions, four different approaches were possible: the transpedicular approach, with reliance on vertebral pedicles as landmarks; the posterolateral approach, which was initiated at a point. Unilateral transpedicular approach was used in most of patients. The metastatic area was sterilized, and local anesthesia of the skin and soft tissues was achieved by injecting 3 mL of 1% lidocaine. The needle tip was positioned as near to anterior margin of vertebral body as possible. The cement injection process was continuously monitored under fluoroscopic control in the lateral plane. Approximately 0.5 mL of prepared bone cement (approximately 20 g PMMA powder mixed with 10 mL monomer until suitable for injection) was then injected prior to scanning. Cement injection was terminated when the PMMA reached the posterior margin of the vertebral body. Immediately, a three-dimensional CT scan was then performed to determine the distribution of the cement after withdrawal of the needle and completion of the PVP (Figures 1 and 2). Antibiotics were administered 1 day before and for 2 days after the procedure.

Bottom Line: Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure.The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05).Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China ; Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, People's Republic of China.

ABSTRACT

Objective: This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) combined with intensity-modulated radiotherapy (IMRT) for metastatic lesions of patients with non-small-cell lung cancer (NSCLC) at centrum vertebrae.

Methods: A total of 39 patients with spinal metastatic NSCLC (stage IV) were treated with PVP followed by IMRT (30 Gy/10F/2 W) for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS), activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline) at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group.

Results: A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05). Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05). No severe complications were observed. Mild complications included two cases (5.13%) of asymptomatic cement leakage into the epidural space and one case (2.56%) of paravertebral leakage. Median survival time was extended to 13 months.

Conclusion: The safety and efficacy of PVP combined with IMRT in patients with NSCLC with metastatic lesions at centrum vertebrae and the ability to prevent the diseased vertebrae from further deformation and tumor infiltration into the vertebral body were demonstrated. PVP combined with IMRT should be the optimal technique for treatment of vertebral compression pain resulting from spinal metastatic NSCLC.

No MeSH data available.


Related in: MedlinePlus