Radiation Treatment Planning After Minimum Metallic Instrumentation for Patients with Spinal Metastases: A Case...

Area of Science:

• Oncology
• Orthopedic Surgery
• Radiation Oncology

Background:

• Non-metallic pedicle screws and rods are increasingly used for spinal tumors.
• Vertebral body replacement (VBR) is sometimes required alongside dorsal fixation.
• Historically, VBR hardware was limited to titanium, but non-titanium options are now available.

Purpose of the Study:

• To compare radiotherapy planning quality after VBR using titanium versus non-titanium materials.
• To assess the impact of VBR implant material on radiation treatment planning for spinal metastatic disease.

Main Methods:

• Retrospective cohort study at a single academic center.
• Included patients with thoracic spinal metastatic disease treated with dorsal fixation and VBR.
• Radiation plan quality evaluated using International Commission on Radiation Units and Measurements criteria on postoperative CT scans.

Main Results:

• Six patients were analyzed, with half receiving titanium VBR and half receiving non-titanium VBR.
• No significant difference was observed in overall radiation plan quality between the two groups.
• Non-titanium implants demonstrated superior visual demarcation during radiation planning.

Conclusions:

• This study is the first to compare radiotherapy planning after VBR with different implant materials.
• Non-titanium VBR provides equivalent radiation plan quality to titanium VBR.
• Superior visual demarcation with non-titanium materials may facilitate more precise radiotherapy delivery in spinal tumor management.