Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine

Michael R. Folkert, Mark H. Bilsky, Gil'ad N. Cohen, Marco Zaider, Eric Lis, George Krol, Ilya Laufer, Yoshiya Yamada

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Purpose: Advances in stereotactic radiosurgery have improved local control of spine metastases, but local failure is still a problem and repeat irradiation is limited by normal tissue tolerance. A novel high-dose-rate (HDR) brachytherapy technique has been developed to treat these previously irradiated lesions. Methods and Materials: Five patients with progressive disease at previously irradiated sites in the spine who were not amenable to further external beam radiation were treated. Catheters were placed intraoperatively in 2 patients and percutaneously implanted in 3 patients with image-guided techniques. Conformal plans were generated to deliver dose to target tissues and spare critical structures. Patients received single-fraction treatment using HDR iridium-192 brachytherapy. Results: Median dose was 14 Gy (range, 12-18 Gy) with a median gross total volume D90 of 75% (range, 31-94%); spinal cord/cauda equina dose constraints were met. At a median followup of 9 months, no local progression of disease has been observed. Four patients had reduction in pain 1-4 weeks after treatment. No brachytherapy-related complications have been observed. Conclusions: Intraoperative and percutaneous iridium-192 HDR spine brachytherapy techniques were not associated with complications or acute toxicity. There has been no local progression at treated sites, and most patients experienced reduction in cancer-related pain.

Original languageEnglish (US)
Pages (from-to)449-456
Number of pages8
Issue number5
StatePublished - Sep 2013


  • Brachytherapy
  • High-dose-rate
  • Metastases
  • Recurrent
  • Reirradiation
  • Spine

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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