Spinal Brachytherapy with 1125 for Malignant Tumors

Nicholas Theodore, MD
WC Huang, MD
Neil Duggal, MD
Leland Rogers, MD
Volker KH. Sonntag MD
Curtis A. Dickman, MD (Phoenix, AZ)

Introduction:

Spinal brachytherapy for various tumors has been well described. its use in the spine, however has not been well characterized.

Methods:

A detailed retrospective analysis with follow–up of 23 patients undergoing spinal brachytherapy at a single institution from 1984–99. All patients underwent implantation of 11 25 seeds during tumor resection.

Results:

Mean age at surgery was 60 years (range 41–81). Tumor location included: cervical, 4 (17%); thoracic, 15 (65%); and lumbar, 4 (17%). Tumor types included: breast, 6 (26%); prostate, 4 (I 7%); sarcoma, 3 (13%); lung, 2; and one case each of hemangioblastoma, bladder, PNET, lymphoma, renal cell, adenocarcinoma of unknown primary, colon and uterine cancer. The average number of seeds implanted per patient was 26.7 (range 10–90). The average dosage of radiation was 12.16 mCi (range 2.8–36). 21 patients (91%) underwent additional external beam radiation averaging 3970 cGy (range 1600–6250). Complications included 1 pulmonary embolus and 2 (8.7%) wound infections, treated in–situ without removal of instrumentation. There were no neurological or other long–term complications attributed to implantation of the radioactive seeds.

Conclusions:

This represents the largest series to date in the literature of implanted 1125 spinal brachytherapy. Surgically implanted spinal brachytherapy seems to be well tolerated. There were no instances of neurological injury and only 2 wound infections in this series. While further analysis is needed, this therapy may be a valuable adjunct in the treatment of these devastating tumors to prevent local recurrence and prolong neurologic integrity.