Clinical Research Of Employing ¹²⁵I Radioactive Seeds Implantation Combined With Surgery For Spinal Metastasis

Objective:Treat the spinal metastasis with 125I radioactive seeds implantation combining surgery and with surgery alone, then compare the clinical outcomes in pain control, general performance, quality of life, local control and, life expandency. To explore the clinical value of 125I radioactive seeds implantation while combined with surgery.Methods:Patients admitted to the spinal surgery department in Shenzhen People's Hospital between Jan,2009 and Mar,2011 with a diagnosis of spinal meatastasis were observed. Those fitted the indications of the study were set into two groups including study group and control group depending on whether 125I radioactive seeds were implanted during surgery. The VAS, KPS, FACT-G were recorded both before surgery and 2 weeks,1,3,6,9,12 months after surgery. Images were reviewed, and life expandency were recorded. Then the statuses between groups were compared through statistic methords.Results:Among all the 8 cases in the study group,2 underwent one-stage posterior neural decompression with stabilization and 125I radioactive seeds implantation,8 were given the percutaneous kyphoplasty combined with the seeds implantation. In the control group,4 of the total 12 cases were given the percutaneous kyphoplasty,5 underwent decompression and kyphoplasty, while the rest 3 were performanced with decompression, kyphoplasty and stabilization. No perioperative period death occurred. No seeds migration or radioractive myelitis was observed. The mean lifetime after surgery is 5.24 months for the study group, and 10.92 months for the control group, while the median lifetime is 3.00 months and 8.00 months accordingly. No statistically difference of the survivor curves is found between groups by Log Rank test, based onχ2=2.219, P=0.136>0.05. The VAS score droped from 8.44 to 4.38 1month after surgery in the study group, while in the control group droped from8.90 to 4.58, and no statistical difference is found between groups using repeated measurement data analysis of variance (P>0.05). The KPS score dropped from 57.50 to 56.25 in the study group one month after surgery, and the score shiftted from 57.50 to 61.66 in the control group. Through repeated measurement data analysis of variance, no statistical difference between groups is found either(P >0.05). Improvement of the FACT-G score in both groups are observed, the one of study group rised from 37.75 to 52.25, while in the control group it improved from 41.3 to 51.00. No statistical difference between groups(P>0.05), but statistically differences are found within each group before and one month after treatment(P<0.05), using repeated measurement data analysis of variance. No more growing in the surgical site is observed through regullar image reviews postoperatively.Conclusion:Combining 125I radioactive seeds implantation with surgery is feasible in clinical practice. While combined with surgery to treat spinal metastasis,125I radioactive seeds implantation seems not to have significant contribution in pain relievement, strength enhancement, bettering the quality of life nor prolonging life expandency. The clinical value of emplying 125I radioactive seeds implantation combined with surgery for spinal metastasis need to be tested through further randomed control study in larger scale and longer follow ups.