Brachytherapy in Spinal Tumors: A Systematic Review.

Background Conventional external beam radiation and stereotactic radiosurgery are common radiation techniques used to treat spinal tumors. Intraoperative brachytherapy (BT) may serve as an alternative when other options have been exhausted or as an adjunct in combination with other therapies. The objective of this study was to systematically review the literature on BT use in spinal tumor surgery. Methods PubMed and Embase databases were systematically queried for literature reporting the use of BT in the surgical treatment of spinal tumors. PRISMA guidelines were followed. A meta-analysis was performed. Results Of the 203 initial articles queried, 15 studies were included. Of the 370 total patients described, 78% were treated for spine metastases. Indications for BT included tumors refractory to previous treatments and inability to tolerate chemotherapy, radiation, and/or open surgery. Seed placement was the most common method of delivery (58%) compared with plaques (42%). BT was placed during an open procedure in 52%, and of the remaining percutaneous procedures, 47% were combined with cement augmentation. Tumor recurrence rates varied from 13% to 49%. Seven studies reporting visual analog scale scores reported significant improvement in pain control. Conclusions BT was used to treat metastatic disease in patients who failed previous therapies and could not tolerate open surgery or further therapy. This review summarizes the major findings in the available literature pertaining to patient background, indications, and outcomes. Spinal BT seems to be a viable option for spine tumor treatment and should be made available at treating centers. Highlights • Indications for BT include tumors refractory to previous treatments and inability to tolerate more therapy and/or surgery. • Iridium 125 in the form of seeds (58%) during an open procedure (52%) was the most common isotope. • Percutaneous delivery combined with cement augmentation (47%) was also common. • Studies with pre- and posttreatment outcomes reported statistically significant improvement in pain and performance status. • Spinal BT seems to be a viable option for spine tumor treatment and should be considered by centers treating spine tumors. [ABSTRACT FROM AUTHOR]