Surgery combined with intraoperative radiotherapy, a new choice of comprehensive treatment for bone tumors

Intraoperative radiotherapy is a treatment method in which patients are treated with single high-dose irradiation in close proximity to the areas requiring radiotherapy (such as primary tumor bed and residual lesion area) while undergoing surgery. Surgical procedures combined with intraoperative radiotherapy treatment for tumor patients can control the scope of radiotherapy very precisely, reduce the dose and duration of postoperative supplemental radiotherapy, thus reducing the incidence of adverse reactions and complications, and effectively reduce surgery-related mortality and cancer recurrence rates.  

  

                                      The live surgery stream of Wang Guowen’s team                          

Currently, under the leadership of Director Wang Guowen, the Department of Bone and Soft Tissue Tumors of Tianjin Medical University Cancer Institute and Hospital has successfully applied intraoperative radiotherapy to the surgical treatment of spinal transthoracic tumors. This can efficiently kill potential residual tumor cells, and achieve the purpose of reducing recurrence and improving survival rate, thus opening up a new path for the comprehensive treatment of malignant bone tumors.


Preoperative MRI image of the patient, with multiplesignal changes in the spine, the responsible lesion is situated in the 8th thoracic vertebral body

   The patient, a 67-year-old woman with a history of colon cancer, came to our hospital complaining of pain in her chest and back, and was finally treated by Director Wang Guowen. The pathological results from a puncture biopsy showed that the tumor was a metastatic adenocarcinoma of the lung, and the imaging examination revealed multiple lymph node and bone metastases in the spine with a pathological fracture of the 8th thoracic vertebrae, necessitating urgent surgery to avoid the risk of paraplegia. After MDT discussion, all experts agreed that the diagnosis was definitely 8th thoracic vertebrae metastasis, the spinal cord was obviously compressed, and the surgery should be mainly palliative. It was suggested that the vertebral mass should be excised, laminectomy and vertebroplasty should be performed to avoid paralysis due to disease progression. Meanwhile, intraoperative radiotherapy was considered essential to reduce the possibility of tumor recurrence in the operated area, ensure the patient's quality of life, and prolong the patient's survival time.

Intraoperative fluoroscopy and intraoperative radiotherapy 

   The operating room department, anesthesia department and radiation therapy department all cooperated to allow the planned surgery to be successfully completed by Director Wang Guowen's team. Intraoperative precise-radio therapy targeting the tumor site was completed using a needle adapter, and the adjacent segment fixation completed, the 8th thoracic vertebroplasty, lamina decompression and mass removal were successfully performed. After the operation, the patient's pain was significantly relieved while the sensation and movement of both lower limbs returned to normal, allowing further comprehensive treatment.


           The patient's postoperative X-ray showed good reconstruction of spinal stability