Case 2
BlackArmor® Carbon/PEEK Implants Enable the Use of High-Precision Proton Therapy
60-year-old female patient with suspected spinal metastasisSettlement of a secondary tumor outside of the primary tumorFirst occurrence of a tumor in a specific area of the body at Th11. The patient’s MRI showed a spinal cord compression caused by a lesion.
Therapy
Surgical treatment through laminectomy, debulkingTerm used in tumor surgery; means removal of the tumor, biopsyTissue removal for examination, and dorsal stabilizationFixation of the spine in a designated position to minimize or eliminate mobility (using posterior or anterior measures) with titanium implants.
Histological finding: ChordomaMalignant tumorTumor with the following characteristics: fast-growing, metastatic, growing into other tissue, unregular growth of the chorda dorsalis (= embryonically created primitive axial skeleton, which regresses in the course of time). The resulting decision for adjuvant proton therapy called for the revision of contraindicated titanium implants and the use of BlackArmor® Carbon/PEEK implants.
Replacement of titanium implants with BlackArmor® Carbon/PEEK implants, dorsal percutaneous stabilizationFixation of the spine in a designated position to minimize or eliminate mobility (using posterior or anterior measures) with the VADER® Pedicle System and anterior stabilizationFixation of the spine in a designated position to minimize or eliminate mobility (using posterior or anterior measures) with the KONG®-TL VBR System


Precise planning and safe performance of the indicated proton therapy could be carried out.

17 months postoperatively no radiological evidence of a tumor
BlackArmor® Carbon/PEEK expands radiation therapyTherapeutic treatment of a disease by means of ionizing radiation options.1Shi C. et al. (2022): Comprehensive Evaluation of Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) Spinal Hardware for Proton and Photon Planning. Technology in Cancer Research & Treatment. (PubMed, PMID: 35410544)5Schmidhalter D. et al. (2020): Dosimetric Analysis of Spine SBRT in Case of CFR-PEEK Implants. Annual SASRO Meeting.7Poel R. et al. (2020): Assessing the Advantages of CFR-PEEK over Titanium Spinal StabilizationFixation of the spine in a designated position to minimize or eliminate mobility (using posterior or anterior measures) Implants in Proton Therapy – A Phantom Study. Physics in Medicine and Biology. (PubMed, PMID: 32315991)8Henzen D. et al. (2022): Feasibility of Postoperative Spine Stereotactic Body Radiation Therapy in Proximity of Carbon and Titanium Hybrid Implants Using a Robotic Radiotherapy Device. Radiation Oncology. (PubMed, PMID: 35549961)Since the tumor entity is not always determined preoperatively, the primary choice of implants is essential. Cutting-edge technologies such as stereotactic body radiotherapy (SBRT) and proton therapy are highly effective and often indicated if conventional radiation therapyTherapeutic treatment of a disease by means of ionizing radiation reaches its limits. ArtifactIn medicine, it is diagnostic error-free imaging is of even greater importance because the adjacent organs at risk must be very precisely delineated during planning. BlackArmor® Carbon/PEEK can optimize the critical planning and validation processes as well as the delivery of the prescribed doseAlso “absorbed dose”; physical quantity indicating the average energy delivered by ionizing radiation to matter of mass.1Shi C. et al. (2022): Comprehensive Evaluation of Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) Spinal Hardware for Proton and Photon Planning. Technology in Cancer Research & Treatment. (PubMed, PMID: 35410544)2Krätzig T. et al. (2021): Carbon-Fiber-Reinforced PEEK versus Titanium Implants: An In Vitro Comparison of Susceptibility Artifacts in CT and MR Imaging. Neurosurgical Review. (PubMed, PMID: 32930911)3Müller BS. et al. (2020): The Dosimetric Impact of Stabilizing Spinal Implants in Radiotherapy Treatment Planning with ProtonsPositively charged particle as nuclear building block of an atom and PhotonsPackets of energy that make up electromagnetic radiationForm of radiation in which energy is transmitted in the form of waves or photons (depending on energy: high energy = photons, low energy = waves); examples: X-rays, gamma rays, radio waves, microwaves, etc.: Standard Titanium Alloy vs. Radiolucent Carbon-Riber-Reinforced PEEK Systems. Journal of Applied Clinical Medical Physics. (PubMed, PMID: 32476247)4Klippel N. (2018): Dosimetric Impact of Titanium and Carbon Implants in Photon Therapy. Annual SSRMP Meeting.5Schmidhalter D. et al. (2020): Dosimetric Analysis of Spine SBRT in Case of CFR-PEEK Implants. Annual SASRO Meeting.6Ringel F. et al. (2017): Radiolucent Carbon Fiber-Reinforced Pedicle Screws for Treatment of Spinal Tumors: Advantages for Radiation Planning and Follow-Up Imaging. World Neurosurgery. (PubMed, PMID: 28478252)7Poel R. et al. (2020): Assessing the Advantages of CFR-PEEK over Titanium Spinal StabilizationFixation of the spine in a designated position to minimize or eliminate mobility (using posterior or anterior measures) Implants in Proton Therapy – A Phantom Study. Physics in Medicine and Biology. (PubMed, PMID: 32315991)