The goal of this clinical research study is to learn whether using body cement on the largest
part of the vertebra (a procedure called vertebral body cement augmentation) can help to
prevent a fracture following stereotactic spinal radiosurgery. Researchers also want to learn
if the procedure can lessen pain and improve quality of life in patients receiving this
If you agree to take part in this study, you will be randomly assigned (as in the flip of a
coin) to 1 of 2 study groups. This is done because no one knows if one study group is better,
the same, or worse than the other group.
- If you are in Group 1, you will receive stereotactic spinal radiosurgery alone (the
standard of care treatment).
- If you are in Group 2, you will receive vertebral body cement augmentation within 4
weeks before or after your stereotactic spinal radiosurgery.
You will have an equal chance of being in either group.
Stereotactic Spinal Radiosurgery:
Both groups will receive standard of care stereotactic spinal radiosurgery. You will sign a
separate consent for this that will explain the procedure and the risks.
If you are in Group 2, your vertebral body cement augmentation will be performed by a
specialist. You will receive a local anesthetic and mild sedation. A small cut is made in
your back and, guided by x-ray images, the specialist will inject body cement into the
largest part of the vertebra to strengthen it. The specialist may also expand the vertebra if
it is at all collapsed. You will lie flat for several hours. You will most likely be
discharged on the same day of the procedure, but you may need to stay overnight in the
No matter which group you are in, you will return to the clinic for follow-up visits every 3
months for 2 years. At these visits, the following tests and procedures will be performed:
- You will have a physical exam.
- You will a magnetic resonance imaging (MRI) to check the status of your spine.
- You will complete 3 questionnaires about your quality of life and any pain you may be
having. The questionnaires should take a total of about 10 minutes to complete.
Length of Study Participation:
Your participation in this study will be over after your follow-up visit at 2 years.
This is an investigational study. Body cement is FDA approved for the treatment of vertebral
body fractures. It is investigational to study if body cement may prevent vertebral body
Up to 80 participants will be enrolled in this study. All will take part at MD Anderson.
1. All patients must have histologic proof of solid tumor malignancy and radiographic
evidence of spine metastasis
2. Age >/= 18 years
3. ECOG performance status </=2 (Karnofsky >/=60%)
4. Life expectancy of greater than 3 months
5. All patients must be able to lie supine
6. All patients must have no more than 3 contiguous vertebral body levels treated at a
single site, and no more than 3 discontiguous vertebral body levels treated
7. All patients must have a single fraction spine radiosurgery at the designated site of
interest to at least a dose of 18 Gy
8. All patients must be deemed at "high risk" of developing vertebral body fracture by
having at least one of the following characteristics: 1) Spine Instability Neoplastic
Score classification of "Indeterminate" deemed as a score from 7 to 12; 2)
Pre-existing vertebral body fracture; 3) Planned radiation dose of 24 Gy
9. All patients must have a vertebral body site to be treated located from T1 to L5.
10. Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and for
the duration of study participation. Should a woman become pregnant or suspect she is
pregnant while she or her partner is participating in this study, she should inform
her treating physician immediately
11. All patients must sign informed consent verifying that they are aware of the
investigational nature of this study in keeping with the rules and policies of M.D.
Anderson Cancer Center. The only acceptable consent is the one approved by M.D.
12. Patients undergoing bisphosphonate therapy are allowed.
1. Patients who have had prior radiotherapy at the spine site and level to be treated
2. Patients who have had prior surgery at the spine level to be treated to include prior
cement augmentation, laminectomy, vertebrectomy, tumor debulking, instrumentation
3. Patients with gross disease involving only the posterior elements
4. Patients who have >50% vertebral body collapse
5. Patients unable to undergo magnetic resonance imaging (MRI) of the spine
6. Patents with cord compression
7. Patients deemed not be a candidate for cement augmentation for any reason
8. Patients who have frank mechanical pain
9. Patients with both pedicles involved with gross disease at the level of potential
10. Pregnant women are excluded from this study because radiation has the potential for
teratogenic or abortifacient effects.
11. Patients with a histology of lymphoma, myeloma and small cell lung cancer histologies
Amol J. Ghia, MD
M.D. Anderson Cancer Center
Amol J. Ghia, MD