Mark Perman, Presenter: Consultant, ArthroCare Corporation Speakers Bureau, ArthroCare Corporation

Richard Kinard MD, Abstract Co-Author: Speakers Bureau, ArthroCare Corporation

Cherylle A. Hayes MD, Abstract Co-Author: Nothing to Disclose

Radiation therapy is the standard of care for symptomatic vertebral metastasis, particularly when the patient has multiple levels of involvement or is a poor surgical candidate. Overall, the response rate to radiotherapy is approximately 80%, with complete relief of pain in only 20-55% suggesting that it alone is ineffective in alleviating pain when there is instability due to vertebral compression fractures (VCF). Percutaneous methylmethacrylate vertebral augmentation (vertebroplasty) is widely used to treat VCF. While it relieves pain, vertebroplasty does not eliminate underlying malignancy. At the time of vertebroplasty, it is also possible to precisely debulk a portion of the tumor tissue. The purpose of this study was to evaluate the feasibility and clinical outcomes of tumor debulking and cement augmentation (vertebroplasty) performed in conjunction with either external beam irradiation or radiosurgery.

Seven patients (6 men, 1 woman), aged 71 ± 10 (56 - 80) years, with painful metastatic-related VCF were treated. The regimen consisted of using a plasma-mediated device (Cavity SpineWand® ArthroCare Corporation, Sunnyvale, CA) to debulk tumor tissue preceding vertebroplasty with injection of methylmethacrylate. Irradiation followed 20 (range = 7 - 31) days later by either external beam irradiation (n = 3; 3000 cGy delivered in 10 fractions or 3250 cGy in 13 fractions; Varian Corporation, Palo Alto, CA) or CyberKnife (n = 3; 1400 - 1700 cGy in a single fraction; n = 1, 3600 cGy in 3 fractions; Accuray Corporation, Sunnyvale, CA) radiosurgery. Pain status was assessed immediately prior to the first procedure, immediately following the second procedure, and at 1 to 3 months follow-up using a 10-point pain scale.

Both procedures were performed in a timely fashion. Patients had a mean pain reduction from 7 ± 3 (range = 4 - 10) preoperatively to 3 ± 2 (range = 0 - 6) immediately following treatment. No complications were observed. Two patients died during the follow-up period; treatment provided no pain relief in one case and complete relief in the other. At 1 to 3 months follow-up, pain scores were ‘2’ for 1 patient, ‘1’ for 1 patient, and ‘0’ for 3 patients.

These procedures worked well as synergistic treatment for painful vertebral compression fractures due to malignancy. All but one of our patients had significant pain relief immediately following the procedure that was sustained or reduced further during follow-up.

Perman, M, Kinard, R, Hayes, C, Vertebroplasty and Radiation Therapy: Synergistic Treatment of Pathologic Compression Fractures.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7001673.html