Can painful bone metastases be treated in a targeted and quick way? Can metastases that are potentially present in the liver and kidneys be adequately treated at the same time as bone metastases? These are the questions that Professor Dr. med. Frederik Wenz from the University Medical Center Mannheim asked himself before going on to develop an innovative surgical technique. After a long development period, this technique is now recognized as an effective cancer therapy.
Malignant tumours are cancerous and often metastasize. The lungs and liver, but also the bones, are the most common locations among the sites for metastatic deposits. Up to 75 percent of all breast cancer patients develop vertebral metastases, which can dissolve bones and cause painful vertebral collapses. The aim of surgery in conventional therapy is to reconstruct and stabilize the spinal column. This usually involves the injection of a special type of bone cement into the fracture site to ensure that the bone does not collapse again (kyphoplasty). The affected vertebrae are then percutaneously irradiated for a period of between two and four weeks. Wenz was able to set another development milestone in the treatment of breast-cancer-related bone metastases: “Our goal is to find a therapy that quickly relieves the pain and at the same time leads to the immediate destruction of abnormal cells without further loss of time.”
In addition to painful bone metastases, progressive visceral metastases in the lungs and liver are usually simultaneously present. However, simultaneous treatment is usually not possible. This leads to a common therapeutic dilemma as to whether to apply a four-week course of radiotherapy to destroy the bone metastases or full-dose chemotherapy to prevent the formation of metastatic deposits in the lungs and the liver. “Whatever treatment we choose, the result is always the same - one of the two types of metastases is not treated efficiently,” says Wenz alluding to the reasons behind his novel Kypho-IORT approach.
Wenz and trauma surgeon colleagues have been using the novel Kypho-IORT approach developed by Wenz since 2009. It is a minimally invasive method that delivers a high dose of intraoperative radiotherapy during kyphoplasty, providing immediate stability, pain relief and sterilization of the metastases at the time of the original operation. Patients no longer have to undergo a four-week radiotherapy course which is usually the case following kyphoplasty. Moreover, chemotherapy can be applied to destroy lung or liver metastases that may be present without the usual delay of several weeks.
Kypho-IORT has already been used to successfully treat more than 90 patients at the Mannheim University Medical Centre; no complications have occurred. During the follow-up period – which admittedly is relatively short – only one patient has developed recurrences. “Patients who have single, painful vertebral metastases that are big enough to potentially touch the spinal cord stand to benefit from the novel approach. This includes around 30 percent of all patients with vertebral metastases,” says Wenz.
The innovative Kypho-IORT procedure is now scientifically recognized. Since 2011, Wenz has been training staff at other centres in the application of this method, sometimes directly on patients within the first clinical application cycle. A multicentre phase III trial is currently awaiting approval from the Federal Office for Radiation Protection (BfS). The trial aims to directly compare the efficiency and outcome of Kypho-IORT and conventional external radiotherapy. “Although we have no results as yet, we are very confident as far as the reduction of local recurrence rates and the improvement of pain relief is concerned. From our point of view, Kypho-IORT is an excellent method for improving the quality of life of the patients concerned,” says Wenz, who is clearly optimistic about the new approach.
Further information:Prof. Dr. Frederik Wenz University Medical Center Mannheim Medical Director Director of the Department of Radiotherapy and RadiooncologyTheodor-Kutzer-Ufer 1-3D-68167 Mannheim Tel. +49 621 383-4960 E-mail: frederik.wenz(at)umm.de