Kypho prior to spine RT

[RadOncBeamer]

When you get a run of the mill referral for palliative spine RT, and the patient has a pathologic fracture, do you ever refer for upfront kyphoplasty before RT? Do you use any specific criteria (pain, spinal instability) for kypho?

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[sirspamalot]

Instability would get my vote. Interesting question as to parameters.

 

[NotMattSpraker]

When you get a run of the mill referral for palliative spine RT, and the patient has a pathologic fracture, do you ever refer for upfront kyphoplasty before RT? Do you use any specific criteria (pain, spinal instability) for kypho?

At my last job, I did combined treatment a fair amount. If there is instability and/or a component of mechanical pain then add a spine eval for surgery or kyphoplasty. You can use a SINS score if you want but if the patient has already been "cleared" for non-surgical treatment, Im not aware of any data using that score to add kyphoplasty or not. For me it was more of a judgement call based on the contribution of mechanical component to overall pain.

Neither of us had an opinion about sequencing, we would just do RT or kypho first based on availability or whatever made sense for the patients global plan.

 

[Doctorer]

The evidence for kypho is incredibly poor. Cochrane has a review that gets updated routinely:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006349.pub4/full

It's still routinely done, but it's not a treatment with good evidence to support it.

 

[evilbooyaa]

Not sure why upfront kypho would be recommended unless it's a true case of instability/pending instability. Why not RT to get the cancer out, then kypho once the hole is as big as it's going to get?

 

[NotMattSpraker]

The evidence for kypho is incredibly poor. Cochrane has a review that gets updated routinely:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006349.pub4/full

It's still routinely done, but it's not a treatment with good evidence to support it.

To me, it's a different clinical setting. The question is whether adding kypho to RT improves quality of life in someone who has had a pathologic fracture from cancer and has pain from instability but is not having surgery. Very specific indication but I'm not sure it's all that rare.

 

[Doctorer]

To me, it's a different clinical setting. The question is whether adding kypho to RT improves quality of life in someone who has had a pathologic fracture from cancer and has pain from instability but is not having surgery. Very specific indication but I'm not sure it's all that rare.

Not sure if mechanical pain from a collapsed vertebral body is different if it’s due to arthritis versus cancer. My views are colored by a friend who is a pain specialist/militantly anti kypho, but at least according to him, kypho is a sham.

 

[grenz]

Not sure why upfront kypho would be recommended unless it's a true case of instability/pending instability. Why not RT to get the cancer out, then kypho once the hole is as big as it's going to get?

We did RT—> kypho for this reason in residency and the IRs were always fine with it

 

[Neuronix]

Not sure why upfront kypho would be recommended unless it's a true case of instability/pending instability. Why not RT to get the cancer out, then kypho once the hole is as big as it's going to get?

This is what I do as well.

Sometimes the IRs do RFA+kypho and we in rad onc are never even consulted.

 

[radoncftw]

This is what I do as well.

Sometimes the IRs do RFA+kypho and we in rad onc are never even consulted.

our IRs always do RFA with kypho.
I thought there was data that kypho improved functional pain quickly. who knows. forget that we are always so critical to require data for anything we do, but everyone else seems to be able to whatever without data.

 

[medgator]

This is what I do as well.

Sometimes the IRs do RFA+kypho and we in rad onc are never even consulted.

"Osteocool"

 

[grenz]

"Osteocool"

This is the Medtronic RFA product they’re pushing

 

[evilbooyaa]

This is what I do as well.

Sometimes the IRs do RFA+kypho and we in rad onc are never even consulted.

WTAF

Rad Oncs opine over evidence base and then IRs just come in and do whatever the hell they want with zero consequences...

 

[medgator]

WTAF

Rad Oncs opine over evidence base and then IRs just come in and do whatever the hell they want with zero consequences...

Totally practice environment dependent. A lot of them end up working on poor ecog inpatients I'm never going to tx anyways

 

[Fpg1245]

WTAF

Rad Oncs opine over evidence base and then IRs just come in and do whatever the hell they want with zero consequences...

Honestly I think we should probably start doing the same. **** it

 

[evilbooyaa]

Honestly I think we should probably start doing the same. **** it

 

[Fpg1245]

To meek and risk averse. The other guys will just shut you out. No one cares if you can quote the study.