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Matsumoto T, Yoshimatsu R, Osaki M, Shibata J, Maeda H, Miyatake K, Noda Y, Yamanishi T, Yamagami T. Analgesic efficacy and safety of percutaneous thermal ablation plus cementoplasty for painful bone metastases: a systematic review and meta-analysis. Int J Clin Oncol 2024; 29:372-385. [PMID: 38217754 DOI: 10.1007/s10147-023-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases. METHODS We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed. RESULTS Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26-7.95, I2 = 89%), 3.30 (95% CI, 2.25-4.82, I2 = 98%), 2.58 (95% CI, 1.99-3.35, I2 = 94%), 2.02 (95% CI, 1.50-2.71, I2 = 93%), 1.78 (95% CI, 1.26-2.53, I2 = 95%), and 1.62 (95% CI, 1.14-2.31, I2 = 88%), and in the subgroup, 7.97 (95% CI, 7.45-8.52, I2 = 86%), 3.01 (95% CI, 1.43-6.33, I2 = 98%), 2.95 (95% CI, 1.93-4.51, I2 = 95%), 2.34 (95% CI, 1.82-3.01, I2 = 68%), 2.18 (95% CI, 1.57-3.03, I2 = 78%), and 2.01 (95% CI, 1.16-3.48, I2 = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2-6%, I2 = 2%). CONCLUSIONS The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction.
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Affiliation(s)
- Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan.
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
- Department of Radiology, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-0111, Japan
| | - Marina Osaki
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
- Department of Radiology, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-0111, Japan
| | - Junki Shibata
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Hitomi Maeda
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Yoshinori Noda
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
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Wu L, Hu M, Li P, Man Q, Yuan Q, Zhang X, Qiu Y, Chen L, Fan J, Zhang K. Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring. J Cancer Res Ther 2024; 20:540-546. [PMID: 38687923 DOI: 10.4103/jcrt.jcrt_1074_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
PURPOSE To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. MATERIALS AND METHODS A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. RESULTS Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. CONCLUSIONS MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.
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Affiliation(s)
- Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated Xuzhou Medical University, Tengzhou City, Shandong Province, China
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Alfonso M, Llombart R, Gil L, Martinez I, Rodríguez C, Álvarez L, Gallego J. Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:480-486. [PMID: 37084999 DOI: 10.1016/j.recot.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8-1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.
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Affiliation(s)
- M Alfonso
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España.
| | - R Llombart
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - L Gil
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - I Martinez
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - C Rodríguez
- Neurorradiologia Intervencionista. Grupo Quirón Hospitales, Madrid, España
| | - L Álvarez
- Departamento de Cirugía Ortopédica y Traumatología. Fundación Jiménez Díaz, Madrid, España
| | - J Gallego
- Departamento de Cirugía Ortopédica y Traumatología. Fundación Jiménez Díaz, Madrid, España
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Alfonso M, Llombart R, Gil L, Martinez I, Rodríguez C, Álvarez L, Gallego J. [Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S480-S486. [PMID: 37541348 DOI: 10.1016/j.recot.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/16/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8 to 1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.
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Affiliation(s)
- M Alfonso
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain.
| | - R Llombart
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - L Gil
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - I Martinez
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - C Rodríguez
- Neurorradiologia Intervencionista, Grupo Quirón Hospitales, Madrid, Spain
| | - L Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - J Gallego
- Departamento de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
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Wang B, Zhang K, Zhang X, Yang S, Hu M, Li P, Yang W, Fan J, Xing C, Yuan Q. Microwave ablation combined with cementoplasty under real-time temperature monitoring in the treatment of 82 patients with recurrent spinal metastases after radiotherapy. BMC Musculoskelet Disord 2022; 23:1025. [PMID: 36443787 PMCID: PMC9706973 DOI: 10.1186/s12891-022-05999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The spine is the most frequently affected part of the skeletal system to metastatic tumors. External radiotherapy is considered the first-line standard of care for these patients with spine metastases. Recurrent spinal metastases after radiotherapy cannot be treated with further radiotherapy within a short period of time, making treatment difficult. We aimed to evaluate the effectiveness and safety of MWA combined with cementoplasty in the treatment of spinal metastases after radiotherapy under real-time temperature monitoring. METHODS In this retrospective study, 82 patients with 115 spinal metastatic lesions were treated with MWA and cementoplasty under real-time temperature monitoring. Changes in visual analog scale (VAS) scores, daily morphine consumption, and Oswestry Disability Index (ODI) scores were noted. A paired Student's t-test was used to assess these parameters. Complications during the procedure were graded using the CTCAE version 5.0. RESULTS Technical success was attained in all patients. The mean VAS score was 6.3 ± 2.0 (range, 4-10) before operation, and remarkable decline was noted in one month (1.7 ± 1.0 [P < .001]), three months (1.4 ± 0.8 [P < .001]), and six months (1.3 ± 0.8 [P < .001]) after the operation. Significant reductions in daily morphine consumption and ODI scores were also observed (P < .05). Cement leakage was found in 27.8% (32/115) of lesions, with no obvious associated symptoms. CONCLUSION MWA combined with cementoplasty under real-time temperature monitoring is an effective and safe method for recurrent spinal metastases after radiotherapy.
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Affiliation(s)
- Baohu Wang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Kaixian Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Xusheng Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Sen Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Miaomiao Hu
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Peishun Li
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Wanying Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Jing Fan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Chao Xing
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Qianqian Yuan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
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Senol N, Oguzoglu AS, Goksel HM. Radiofrequency Ablation and Augmentation in the Management of Spinal Metastases: Clinical Experience in 41 Patients. World Neurosurg 2022; 163:e420-e425. [PMID: 35395426 DOI: 10.1016/j.wneu.2022.03.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate functional outcome after combined radiofrequency ablation and vertebral augmentation in patients with metastatic spinal tumors using visual analog scale and Oswestry Disability Index scores. METHODS This retrospective study included 41 patients with metastatic spinal tumors. There were 19 women and 22 men with a mean age of 67 years (range, 45-87 years). Visual analog scale and Oswestry Disability Index were used to assess the intensity of pain and quality of life. The assessments were performed before the procedure and at 1 week and 1, 2, 3, and 6 months after the procedure. RESULTS No serious complications were seen in the periprocedural period. Two patients (4.8%) had transient neurological motor deficits without cement leakage, and 1 patient had a pulmonary embolism with transient mild symptoms. The comparison of preprocedural visual analog scale and Oswestry Disability Index scores with postprocedural scores up to 6 months after treatment revealed significant pain control and good functional state. CONCLUSIONS Spinal metastasis is a frequent entity in the growing population of patients with cancer. A multidisciplinary approach using several nonsurgical and minimally invasive methods (e.g., radiofrequency ablation, vertebroplasty, balloon kyphoplasty) is key to successful management, and combining these procedures is effective against spinal metastatic pain.
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Affiliation(s)
- Nilgun Senol
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Ali Serdar Oguzoglu
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Hakan Murat Goksel
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Giammalva GR, Costanzo R, Paolini F, Benigno UE, Porzio M, Brunasso L, Basile L, Gulì C, Pino MA, Gerardi RM, Messina D, Umana GE, Palmisciano P, Scalia G, Graziano F, Visocchi M, Iacopino DG, Maugeri R. Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series. Front Oncol 2022; 11:818760. [PMID: 35127531 PMCID: PMC8814334 DOI: 10.3389/fonc.2021.818760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022] Open
Abstract
Spine is a frequent site of bone metastases, with a 8.5 months median survival time after diagnosis. In most cases treatment is only palliative. Several advanced techniques can ensure a better Quality of Life (QoL) and increase life expectancy. Radiofrequency ablation (RFA) uses alternating current to produce local heating and necrosis of the spinal lesion, preserving the healthy bone. RFA is supported by vertebral reinforcement through kyphoplasty and vertebroplasty in order to stabilize the fracture with polymethylmethacrylate (PMMA) injection, restoring vertebral body height and reducing the weakness of healthy bone. The aim of this study is to demonstrate the efficacy and advantages of RFA plus vertebral reinforcement through PMMA vertebroplasty and fixation in patients affected by bone spinal metastases. We retrospectively analyzed 54 patients with thoraco-lumbar metastatic vertebral fractures admitted to our Unit between January 2014 and June 2020. Each patient underwent RFA followed by PMMA vertebroplasty and transpedicle fixation. We evaluated pain relief through the Visual Analogue Scale (VAS) Score and PMMA vertebral filling based on the mean Saliou filling score. Analysis of variance (ANOVA) was used to test pain relief with statistical significance for p<0.05. A total of 54 patients (median age 63,44 years; range 34-86 years), with a total of 63 infiltrated vertebrae, were treated with RFA, PMMA vertebroplasty and transpedicular screw fixation; average operative time was 60.4 min (range 51–72). The preoperative average VAS score decreased significantly from 7.81 to 2.50 (p < 0.05) after 12 months. Based on Saliou filling score, filling was satisfactory (12–18) in 20 vertebrae (31,7%), mediocre (6–11) in 33 vertebrae (52,4%), inadequate (0–5) in 10 vertebrae (15,9%). A consistent PMMA filling of vertebral bodies was successfully achieved with significant pain relief. Concomitant RFA, PMMA vertebroplasty and pedicle screw fixation represent a safe and effective technique for the management of spinal metastases, improving clinical outcome and pain control.
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Affiliation(s)
- Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Federica Paolini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Umberto Emanuele Benigno
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Luigi Basile
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Carlo Gulì
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Maria Angela Pino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Messina
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital Trauma Center Gamma Knife Center, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurosurgery, Cannizzaro Hospital Trauma Center Gamma Knife Center, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy
| | - Francesca Graziano
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy
| | - Massimiliano Visocchi
- Institute of Neurosurgery, Catholic University School of Medicine, Policlinico “A. Gemelli”, Rome, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
- *Correspondence: Rosario Maugeri,
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Kastler A, Barbé DA, Alemann G, Hadjidekov G, Cornelis FH, Kastler B. Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient's Experience and Pain Outcome. MEDICINA-LITHUANIA 2021; 57:medicina57090966. [PMID: 34577889 PMCID: PMC8466129 DOI: 10.3390/medicina57090966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, CHUGA Grenoble Hospital, Université Grenoble Alpes, 38400 Saint Martin d’Heres, France
- Correspondence:
| | | | | | - Georges Hadjidekov
- Department of Radiology, University Hospital Lozenets, 1407 Sofia, Bulgaria;
| | - Francois H. Cornelis
- Adult Radiology Department, Necker Hospital, Paris V University, 75015 Paris, France;
| | - Bruno Kastler
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
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Shawky Abdelgawaad A, Ezzati A, Krajnovic B, Seyed-Emadaldin S, Abdelrahman H. Radiofrequency ablation and balloon kyphoplasty for palliation of painful spinal metastases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2874-2880. [PMID: 33961090 DOI: 10.1007/s00586-021-06858-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE This study was designed with an aim to assess the safety and early postoperative outcomes of the combined Radiofrequency ablation (RFA) and Balloon Kyphoplasty (BKP) used for the treatment of painful neoplastic spinal lesions palliatively. PATIENTS AND METHODS Between December 2015 and December 2018, 60 patients (35 men and 25 women) with spinal metastases were operated using RFA and BKP at our institution. Transpedicular biopsy was performed in all cases. Patients' demographics, lesion characteristics, concurrent palliative therapies and complications were recorded. All patients were clinically (Pain score VAS 0-10) and radiologically evaluated pre- and postoperatively. Retrospective analysis of data for this cohort was performed. RESULTS Seventy-five painful spinal metastases (46 in the lumbar spine and 29 in the thoracic region) in 60 patients were operated [transpedicular RFA alone in 5 lesions, and in combination with BKP in 70 lesions (93%)]. The mean pre-procedure and post-procedure VAS for back pain was 7.2/10 and 2.7/10, respectively (p value = 0.0001). No neurological complications related to RFA were found and no cement extravasation into the spinal canal was observed. In two patients, asymptomatic leaks into the needle track, in two patients into draining veins and in one patient into the disk space were detected. CONCLUSION Combined RFA and BKP appears to be a safe, practical, effective and reproducible palliative treatment for painful spinal osteolytic metastasis. In carefully indicated cases, it relieves pain and maintains stability in a minimal invasive way without adding significant surgical trauma or complications.
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Affiliation(s)
- Ahmed Shawky Abdelgawaad
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany. .,Department of Orthopaedics, Assiut University Hospitals, Assiut, 71515, Egypt.
| | - Ali Ezzati
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Branko Krajnovic
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Sadat Seyed-Emadaldin
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Hamdan Abdelrahman
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
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10
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Ke J, Cheng S, Yang T, Zhang C, Wang M, Zhang Y. Feasibility of Controlling Metastatic Osseous Pain Using Three Kinds of Image-Guided Procedures for Thermal Microwave Ablation: A Retrospective Study. Orthop Surg 2020; 13:116-125. [PMID: 33305522 PMCID: PMC7862186 DOI: 10.1111/os.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the feasibility and safety of treating painful osseous metastases using image‐guided percutaneous thermal microwave ablation. Methods This is a retrospective study of patients treated from December 2016 to December 2019 in one institute. A total of 50 patients (35 men, 15 women; mean age 55.24 ± 11.03 years) with 56 osseous metastatic lesions underwent image‐guided percutaneous microwave ablation. There were 7 patients with multiple and 43 patients with single metastases. The numbers of patients with primary cancer were as follows: lung, 13; liver, 17; kidney, 10; prostate, 1; breast, 3; osteosarcoma, 1; and thyroid, 5. Seventeen patients had cancer combined with soft tissue masses. The radiological images for the ablative procedures were obtained by CT, fluoroscopy with ultrasound, and fluoroscopy alone in 16, 11, and 23 patients, respectively. Pain severity was estimated using the visual analogue scale before and after treatment (1 week, 1 month, and 3 months after treatment). Radiological evaluations were performed at baseline and 3 months after the procedure. Results In all patients, pain reduction occurred from the first day after treatment. Pain did not recur during the 3 months of follow up. The mean total ablation time per microwave electrode was 3.99 ± 2.48 min (range, 1–15 min). The mean power of the microwave electrode was 66.40 ± 12.08 W. The average volume of bone (load‐bearing bone, such as vertebra and acetabulum) cement after ablation was 2.82 ± 0.81 mL. There were no significant differences in visual analogue scale pain scores for different imaging techniques or ablation energies. No procedure‐related complications occurred. Conclusion Image‐guided percutaneous thermal microwave ablation of osseous metastases relieves pain and improves mobility. CT remains the first choice for percutaneous ablation. Fluoroscopy combined with ultrasound is effective for cases with soft tissue masses; fluoroscopy is also suitable for combination with vertebroplasty. However, further investigations are required. (A) Microwave ablation probe. (B) Temperature probe in the vertebral body and in the vertebral pedicle (parallel to the posterior margin). (C) Metastatic tumor. The thick white line of the ablation probe tip represents the source of microwave needle emission. The orange region represents the heating range of the microwave.
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Affiliation(s)
- Jin Ke
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chi Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Wang
- Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yu Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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11
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Effectiveness of Radiofrequency Ablation in the Treatment of Painful Osseous Metastases: A Correlation Meta-Analysis with Machine Learning Cluster Identification. J Vasc Interv Radiol 2020; 31:1753-1762. [DOI: 10.1016/j.jvir.2020.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 12/17/2022] Open
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12
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Clarençon F, Shotar E, Cormier E, Premat K, Drir M, Lahlou G, Morel V, Spano JP, Bonaccorsi R, Di Maria F, Hervochon R, Pascal-Mousselard H, Chiras J. Transoral vertebroplasty for the C1 lateral mass. J Neurointerv Surg 2020; 12:879-885. [PMID: 32354844 DOI: 10.1136/neurintsurg-2020-015853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteolytic lesions of the atlas (C1) are challenging to treat by vertebroplasty due to the vicinity of the vertebral artery and the spinal cord. OBJECTIVE To present our experience with transoral vertebroplasty (TOV) for osteolytic lesions of the lateral mass of the atlas. METHODS Retrospective case series involving 15 consecutive patients (nine male, six female, mean age 63 years) who underwent TOV for the treatment of an osteolytic lesion of the lateral mass of the atlas. Among the osteolytic lesions, 10/15 (67%) were bone metastases from various cancers; 4/15 (27%) were lesions related to multiple myeloma; and one lesion (7%) was an aggressive hemangioma. All the TOVs were performed under general anesthesia and in most cases (10/15; 67%) in a hybrid angiosuite combining a C-arm flat panel and a CT scan. The remaining five patients were treated under biplane fluoroscopic guidance. RESULTS Vertebroplasty of the lateral mass of C1 through a transoral route was feasible in all cases. Significant pain relief was obtained in most cases (1 month average decrease in Numeric Rating Scale: 4.9±4.1). No major complication was recorded. In 7/15 cases (47%), cement leakage surrounding the C1 lateral mass was seen; none of these leakages had a significant clinical consequence. No additional spine surgery was required in any of the patients. CONCLUSION TOV of osteolytic lesions of the lateral mass of the atlas is feasible and seems safe and effective, providing pain relief and bone stabilization.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne Université, Paris, France .,Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Evelyne Cormier
- Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Kevin Premat
- Sorbonne Université, Paris, France.,Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Mehdi Drir
- Department of Neuro-intensive care, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Ghizlene Lahlou
- Sorbonne Université, Paris, France.,Department of Otorhinolaryngology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Veronique Morel
- Department of Hematology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Jean-Philippe Spano
- Sorbonne Université, Paris, France.,Department of Oncology, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Raphaël Bonaccorsi
- Department of Orthopedic Surgery, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | | | - Rémi Hervochon
- Department of Otorhinolaryngology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Hugues Pascal-Mousselard
- Sorbonne Université, Paris, France.,Department of Orthopedic Surgery, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Jacques Chiras
- Sorbonne Université, Paris, France.,Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
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13
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Qiu YY, Zhang KX, Ye X, Zhang XS, Xing C, Wu QS, Hu MM, Li PX, Wang JJ. Combination of Microwave Ablation and Percutaneous Osteoplasty for Treatment of Painful Extraspinal Bone Metastasis. J Vasc Interv Radiol 2019; 30:1934-1940. [PMID: 31669085 DOI: 10.1016/j.jvir.2019.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of microwave (MW) ablation combined with percutaneous osteoplasty (POP) on painful extraspinal bone metastases. MATERIALS AND METHODS In this retrospective study, 50 adult patients with 56 extraspinal bone metastasis lesions, who suffered from refractory moderate to severe pain, were treated with MW ablation and POP. Changes in quality of life were evaluated based on the Visual Analog Scale (VAS), daily morphine consumption, and the Oswestry Disability Index (ODI) before and immediately after the procedure and during follow-up times. RESULTS Technical success was achieved in all patients. Mean preoperative VAS score and morphine dose were 7.0 ± 2.6 (range, 3-10) and 66.7 ± 33.2 mg (range, 10-120 mg), respectively. Mean postoperative VAS scores and daily morphine doses were as follows: 1 day, 3.5 ± 2.1 and 36.1 ± 25.8 mg (P < .05); 1 week, 1.5 ± 1.7 and 12.2 ± 14.8 mg (P < .001); 1 month, 0.9 ± 1.4 and 5.7 ± 10.0 mg (P < .001); and 3 months, 0.6 ± 1.2 and 4.7 ± 8.4 mg (P < .001). A significant decrease in the ODI score was also observed (P < .05). Periprocedural death was not observed. A pathologic fracture occurred in 1 (2%) patient with femoral metastasis, and local infection was observed in 2 (4%) patients. Minor cement leakage occurred in 4 (8%) patients with no symptomatic or intra-articular extravasation. No local tumor progression occurred in patients with imaging follow-up. CONCLUSIONS MW ablation combined with POP is an effective and safe treatment for painful extraspinal bone metastases, which can significantly relieve pain and improve quality of life.
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Affiliation(s)
- Yuan-Yuan Qiu
- Departments of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China
| | - Kai-Xian Zhang
- Departments of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China.
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xu-Sheng Zhang
- Departments of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China
| | - Chao Xing
- Departments of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China
| | - Qing-Song Wu
- Hepatobiliary and Vascular Surgery, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China
| | - Miao-Miao Hu
- Departments of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, Shandong Province 277500, China
| | - Peng-Xin Li
- Department of Oncology, Zouping People's Hospital, Binzhou City, China
| | - Jun-Jie Wang
- Department of Radiation Oncology, Peking University Third Hospital, No. 49, Beijing, China
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14
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Huntoon K, Eltobgy M, Mohyeldin A, Elder JB. Lower Extremity Paralysis After Radiofrequency Ablation of Vertebral Metastases. World Neurosurg 2019; 133:178-184. [PMID: 31606502 DOI: 10.1016/j.wneu.2019.09.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. CASE DESCRIPTION This report describes a case of a 61-year-old woman who underwent RFA and kyphoplasty for spinal metastases and noted the immediate onset of lower extremity paralysis after the procedure. To the best of our knowledge, this is the first documented case of permanent lower extremity paralysis in the medical literature after radiofrequency thermal ablation of spine metastases. CONCLUSIONS Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Mostafa Eltobgy
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ahmed Mohyeldin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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15
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Application of Percutaneous Osteoplasty in Treating Pelvic Bone Metastases: Efficacy and Safety. Cardiovasc Intervent Radiol 2019; 42:1738-1744. [DOI: 10.1007/s00270-019-02320-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
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16
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Lee SK, Weiss B, Yanamadala V, Brook A. Percutaneous Interventional Management of Spinal Metastasis. Semin Intervent Radiol 2019; 36:249-254. [PMID: 31435133 DOI: 10.1055/s-0039-1694698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spinal metastasis is usually associated with debilitating pain and results in deteriorating life quality. The role of percutaneous management of spinal metastasis has evolved from a diagnostic role to a significant part of therapeutic options in conjunction with conventional management techniques, including radiotherapy and open surgical options. Percutaneous vertebral augmentation (PVA) showed substantial pain reduction, vertebral stabilization, and improvement of quality of life. Minimally invasive local ablative procedures (MILAPs) demonstrated significant pain reduction, local tumor burden control, and improvement of quality of life. Though combined PVA and MILAP's synergistic role in pain reduction may need additional investigation, considering different actions on spine metastasis patients, combining both techniques might beneficial to selected patients. The role of percutaneous management will likely expand since its role in improving patient's quality of life with very minimal procedure-related risk and in conjunction with future technological advancement.
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Affiliation(s)
- Seon-Kyu Lee
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Brandon Weiss
- Department of Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Vijay Yanamadala
- Department of Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Allan Brook
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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17
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Shi G, Feng F, Chen H, Jia P, Bao L, Tang H. Multilevel percutaneous kyphoplasty in painful osteolytic vertebral metastases: a study of the efficacy and safety. J Pain Res 2019; 12:1053-1060. [PMID: 31114293 PMCID: PMC6497850 DOI: 10.2147/jpr.s193564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/27/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose: The spine is the most common skeletal site for metastatic tumors. In the treatment of vertebral metastases, the absolutely safe number of levels that can be treated via percutaneous kyphoplasty (PKP) during one procedure remains controversial. Thus, the present study aimed to evaluate the safety and efficacy of multilevel (>3) PKP for painful osteolytic vertebral metastases. Patients and methods: We retrospectively analyzed the data from 176 patients who received PKP for painful osteolytic spinal metastases. Group A (n=104) received PKP at a maximum of three vertebral levels per procedure, while group B (n=72) received PKP at more than three levels during one operation. Surgical efficacy was assessed via a comparison of the VAS, Oswestry Disability Index (ODI), and general health (GH) and mental health (MH) scores of the Short Form-36 Health Survey before and after PKP. The complications were observed to evaluate the safety. Results: Both groups had significantly improved VAS, ODI, GH and MH scores after PKP (P<0.05). One week after surgery, group A had significantly less pain (VAS 3.41±0.1) than group B (VAS 3.74±0.13) (P<0.05). At 3 and 6 months postoperatively, the GH score was more significantly improved in group A than group B (P<0.05). There were no significant differences between the two groups in the ODI, MH score, and complications (P>0.05). Conclusion: Multilevel PKP is safe and results in effective pain relief, and improvement of spinal mobility and GH in patients with osteolytic vertebral metastases. However, patients who undergo PKP at more than three levels have slightly worse short-term pain relief (less than 1 week postoperatively) and improvement of GH in the long-term (more than 3 months postoperatively) compared with patients who undergo PKP at less than three levels.
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Affiliation(s)
- Guan Shi
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fei Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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18
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Which Combination Treatment Is Better for Spinal Metastasis: Percutaneous Vertebroplasty With Radiofrequency Ablation, 125I Seed, Zoledronic Acid, or Radiotherapy? Am J Ther 2019; 26:e38-e44. [PMID: 29087367 DOI: 10.1097/mjt.0000000000000449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) can not only alleviate pain but also restore mechanical stability with injection of bone cement, whereas it exhibits a poor effect on antitumor activity. But through combinations with other therapies, it may be possible to achieve the maximum effect in clinical treatment. Thus, this study is designed to assess the clinical efficacy of PVP separately combined with 4 ways for spinal metastasis (SM) treatment. STUDY QUESTION Which combination treatment is better for spinal metastasis, percutaneous vertebroplasty with radiofrequency ablation, I seed, zoledronic acid or radiotherapy? STUDY DESIGN A total of 169 patients with SM were retrospectively recruited and randomly assigned to 4 groups to receive 4 different ways separately: 49 patients (group A) received PVP plus I seed, 51 (group B) received PVP plus radiofrequency ablation (RFA), 38 (group C) underwent PVP plus zoledronic acid (ZA), and 31 (group D) underwent PVP plus radiotherapy (RT). MEASURES AND OUTCOMES All of them underwent routine examinations before operation. Visual analog scale (VAS), World Health Organization (WHO) Pain Relief, and ODI were applied to evaluate pain relief and motor function. RESULTS PVP plus RT achieved the best efficacy in relieving pains, with the highest WHO Pain Relief (P < 0.05). The PVP plus RFA exhibited lowest ODI, suggesting the best outcome after treatment (P < 0.05). The PVP plus I showed the lowest VAS score, but it was the worst to improve the routine exercise ability and relieve pains from patients. The PVP plus ZA presented higher VAS and ODI (P < 0.05). CONCLUSIONS PVP combined with I seed exhibited the best clinical efficacy in terms of VAS, PVP combined with RT was the best choice in terms of WHO Pain Relief, and PVP combined with RFA showed the best effect in terms of ODI for the treatment of SM.
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19
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Burgard CA, Dinkel J, Strobl F, Paprottka PM, Schramm N, Reiser M, Trumm CG. CT fluoroscopy-guided percutaneous osteoplasty with or without radiofrequency ablation in the treatment of painful extraspinal and spinal bone metastases: technical outcome and complications in 29 patients. ACTA ACUST UNITED AC 2018; 24:158-165. [PMID: 29770769 DOI: 10.5152/dir.2018.17265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the safety and technical outcome of computed tomography (CT) fluoroscopy-guided osteoplasty with or without prior percutaneous radiofrequency ablation (RFA) in patients with painful osteolyses. METHODS We performed a retrospective analysis of 29 patients with painful extraspinal and spinal osteolyses (16 women, 13 men; 63.1±14.4 years) who underwent CT fluoroscopy-guided osteoplasty (10-20 mAs tube current) with or without RFA (26 and 14 lesions, respectively), in 33 consecutive procedures from 2002 to 2016. Technical success was defined as at least one complete RFA cycle and subsequent polymethyl metacrylate (PMMA) bone cement injection covering ≥75% of longest diameter of extraspinal osteolysis on axial plane or of distance between vertebral endplates. Procedure-related complications within 30 days and dose-length-product (DLP) were also evaluated. RESULTS Osteolyses were located in the pelvis (acetabulum, n=10; iliac bone, n=4), spine (thoracic, n=6; lumbar, n=5; sacral, n=8), long bones (femur, n=3; tibia, n=1), sternum (n=2) and glenoid (n=1). Mean size of the treated osteolysis was 4.0±1.2 cm (range, 1.9-6.9 cm). Of 40 osteolyses, 31 (77.5%) abutted neighboring risk structures (spinal canal or neuroforamen, n=18; neighboring joint, n=11; other, n=8). Mean number of RFA electrode positions and complete ablation cycles was 1.5±0.9 and 2.1±1.7, respectively. Mean PMMA filling volume was 7.7±5.7 mL (range, 2-30 mL). Small asymptomatic PMMA leakages were observed in 15 lesions (37.5%). Mean total DLP was 850±653 mGy*cm. Six minor complications were observed, without any major complications. CONCLUSION CT fluoroscopy-guided percutaneous osteoplasty with or without concomitant RFA for the treatment of painful extraspinal and spinal osteolyses can be performed with a low complication rate and high technical success.
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Affiliation(s)
- Caroline A Burgard
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Julien Dinkel
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Frederik Strobl
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Philipp M Paprottka
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Nicolai Schramm
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Christoph G Trumm
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
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20
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Laredo JD, Chiras J, Kemel S, Taihi L, Hamze B. Vertebroplasty and interventional radiology procedures for bone metastases. Joint Bone Spine 2018; 85:191-199. [DOI: 10.1016/j.jbspin.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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21
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Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update. Curr Treat Options Oncol 2017; 18:74. [DOI: 10.1007/s11864-017-0516-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Wei Z, Ye X, Yang X, Zheng A, Huang G, Dong S, Li W, Wang J, Han X, Meng M, Ni Y. The efficacy and safety of microwave ablation in patients with retroperitoneal metastases. Int J Hyperthermia 2017; 34:1053-1060. [PMID: 29082799 DOI: 10.1080/02656736.2017.1390788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Retroperitoneal metastases are common, and most present with symptoms; however, treatments for this condition are limited. This retrospective study verified the efficacy and safety of microwave ablation (MWA) in retroperitoneal metastases patients. METHODS Patients with pathologically confirmed malignant carcinoma and imaging showing retroperitoneal metastases were enrolled and underwent MWA. The end-points included objective response rate, time to local progression (TTLP), overall survival, visual analogue scale (VAS) score, dose of morphine pre- and post-ablation and complications. RESULTS Twenty-three patients were enrolled. The mean tumour diameter was 3.6 cm. Altogether, 29 tumour sites in 23 patients were ablated during 23 procedures; technical success was achieved in all 23 patients. The objective response and disease control rates were 95.7% and 100.0%, respectively. The mean TTLP and median OS were 22.8 months (95% CI: 16.1-29.6 months) and 10.6 months (95% CI: 7.4-13.8 months), respectively. In 13 patients with symptoms, the VAS values before ablation and 48 h, 1 month, 2 months, 3 months and 6 months after ablation were 5.38, 2.77 (p = 0.015), 2.15 (p = 0.001), 2.17 (p = 0.001), 1.40 (p = 0.000) and 1.71 (p = 0.006), respectively. The corresponding morphine doses were 76.9 mg, 70.7 mg (p = 0.584), 50.7 mg (p = 0.031), 55.0 mg (p = 0.097), 46.0 mg (p = 0.057) and 40.0 mg (p = 0.363), respectively. No ablation-associated mortality was observed. Major complications, minor complications and adverse events were observed in eight (34.8%), five (21.7%) and four (17.4%) patients, respectively. CONCLUSION MWA for the treatment of retroperitoneal metastases was effective and the complications were common.
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Affiliation(s)
- Zhigang Wei
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xin Ye
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xia Yang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Aimin Zheng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Guanghui Huang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Shenming Dong
- b Department of Oncology , Pingyuan People's Hospital , Shandong Province , China
| | - Wenhong Li
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Jiao Wang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xiaoying Han
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Min Meng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Yang Ni
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
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Chiras J, Shotar E, Cormier E, Clarençon F. Interventional radiology in bone metastases. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12741] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J. Chiras
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
| | - E. Shotar
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
| | - E. Cormier
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
| | - F. Clarençon
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
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CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol 2017; 46:539-545. [PMID: 28191595 DOI: 10.1007/s00256-017-2584-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. MATERIALS AND METHODS Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. RESULTS All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. CONCLUSIONS Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience.
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25
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Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region. Eur Radiol 2017; 27:3973-3982. [PMID: 28289933 DOI: 10.1007/s00330-017-4774-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur. METHODS Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22-85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1-27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS). RESULTS No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0-10) to 2.3 ± 2.4 (range 0-7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded. CONCLUSION RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery. KEY POINTS • Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty. • RC provides effective bone stability and pain relief. • RC is a suitable minimally invasive option for patients in poor general condition.
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Kastler A, Krainik A, Sakhri L, Mousseau M, Kastler B. Feasibility of Real-Time Intraprocedural Temperature Control during Bone Metastasis Thermal Microwave Ablation: A Bicentric Retrospective Study. J Vasc Interv Radiol 2017; 28:366-371. [DOI: 10.1016/j.jvir.2016.09.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022] Open
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27
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Wallace M, Aboulafia A. Salvage Therapy and Palliative Care for Metastatic Sarcoma. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yoong J, Chandra RV, William L, Franco M, Goldschlager T, Runacres F, Poon P. Percutaneous Sacroplasty for Painful Bone Metastases: A Case Report. Pain Pract 2016; 17:945-951. [PMID: 27910200 DOI: 10.1111/papr.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/08/2016] [Accepted: 10/16/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The occurrence of bone metastases is common in patients with advanced cancer. The literature supports percutaneous vertebroplasty and kyphoplasty as minimally invasive procedures to relieve pain and improve quality of life for selected patients with disabling pain from pathological vertebral fractures secondary to bone metastases. CASE We describe a case of a 71-year-old patient with castrate-resistant metastatic prostate cancer who underwent sacroplasty for painful sacral metastases. The patient had previously been treated with maximally tolerated analgesics and anticancer therapies including systemic anticancer treatments and local radiotherapy. After sacroplasty, he experienced significant pain reduction and improvement in mobility and function. CONCLUSION This case and recent literature demonstrate positive outcomes of sacroplasty in terms of pain reduction and improved mobility. Further research is warranted to establish the role of such minimally invasive percutaneous procedures for pain management in cancer patients.
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Affiliation(s)
- Jaclyn Yoong
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Northern Health, Melbourne, Victoria, Australia
| | - Ronil Vikesh Chandra
- Monash University, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - Michael Franco
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Tony Goldschlager
- Monash University, Melbourne, Victoria, Australia.,Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Calvary Health Care Bethlehem, Melbourne, Victoria, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Palliative Care, Melbourne, Victoria, Australia
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Zhang JJ, Zhou Y, Hu HY, Sun YJ, Wang YG, Gu YF, Wu CG, Shen Z, Yao Y. Safety and efficacy of multilevel vertebroplasty for painful osteolytic spinal metastases: a single-centre experience. Eur Radiol 2016; 27:3436-3442. [PMID: 27975147 DOI: 10.1007/s00330-016-4683-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/03/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To retrospectively assess the safety and efficacy of percutaneous vertebroplasty (PVP) for painful osteolytic spinal metastases when treating more than three vertebrae per session. METHODS A total of 153 patients with painful osteolytic spinal metastases underwent PVP. Group A patients (n = 93) underwent PVP at up to three vertebral levels per session. Group B patients (n = 60) underwent PVP at more than three levels in one session. Pain, quality of life (QoL), and mobility were assessed before and after PVP. Minor and major complications were systematically assessed. RESULTS Both groups experienced significant pain relief and QoL improvement after the intervention (p < 0.001). Mobility improvement was observed in both groups, despite worse mobility status before PVP in group B compared with group A. There was no significant difference between the two groups throughout the follow-up period in overall pain relief and improvement in QoL and mobility. There was also no significant difference between groups in minor and major complications. CONCLUSIONS Multilevel vertebroplasty is safe and effective for the treatment of multiple osteolytic spinal metastases. Multilevel PVP relieves pain and improves QoL and mobility. KEY POINTS • Percutaneous vertebroplasty is safe and effective for painful osteolytic spinal metastases. • Multilevel vertebroplasty does not cause more complications than single-level vertebroplasty. • Multiple spinal metastases patients may regain functional independence after multilevel vertebroplasty.
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Affiliation(s)
- Jian-Jun Zhang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yan Zhou
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Hai-Yan Hu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yuan-Jue Sun
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yong-Gang Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yi-Feng Gu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Chun-Gen Wu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Zan Shen
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yang Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
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Wei Z, Zhang K, Ye X, Yang X, Zheng A, Huang G, Wang J. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer. Skeletal Radiol 2015; 44:1485-90. [PMID: 26112311 DOI: 10.1007/s00256-015-2195-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/31/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. MATERIALS AND METHODS From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. RESULTS Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28%); among these, major complications were reported in two (7.7%) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1% (6/26). CONCLUSION MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, 250021, China,
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Pezeshki PS, Davidson SR, Akens MK, Murphy K, McCann C, Sherar M, Whyne CM, Yee AJM. Helical coil electrode radiofrequency ablation designed for application in osteolytic vertebral tumors--initial evaluation in a porcine model. Spine J 2015; 15:1832-40. [PMID: 25819585 DOI: 10.1016/j.spinee.2015.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiofrequency ablation (RFA) is emerging as a complementary treatment for vertebral metastases. Traditional RFA induces frictional heating leading to local tissue necrosis but often yields small, incomplete, and inhomogeneous zones of ablation in bone. We have developed a new bone-specific RFA electrode that uses a nontraditional frequency (27.12 MHz) and geometry (helical), exploiting a magnetic field and an electric field to generate larger and more comprehensive treatment zones. PURPOSE The purpose of the study was to evaluate the feasibility and safety of the Bone Coil RFA electrode in the spine. STUDY DESIGN This is a preclinical in vivo study based on basic science. METHODS Under institutional approval, six healthy Yorkshire pigs received a sham and an RF treatment in two adjacent cervical vertebrae. To deploy the Bone Coil RFA device in dense porcine vertebrae, a surgical approach was required; an irrigated coring drill bit created a cylindrical path in the vertebral bodies through which the RFA electrodes were placed. The electronic circuit was completed by four grounding pads. Treatment was delivered for 10 minutes at 20 W (n=1), 25 W (n=1), and 30 W (n=4). To monitor the thermal rise and for safety, fiber-optic probes recorded temperatures in the center of each coil and near the spinal foramen. After the procedure, animals were monitored for 2 weeks. Magnetic resonance imaging (MRI) was completed immediately after treatment and at 14 days. Magnetic resonance image segmentation and histology were used to evaluate the ablation volume. RESULTS Comprehensive treatment of the porcine vertebrae was demonstrated by temperature monitoring, MRI, and histology. Large zones of RF ablation were obtained (RF: 3.72±0.73 cm3 vs. sham: 1.98±0.16 cm3, p<.05), confined within the vertebral body. Internal temperatures were elevated with RF (66.1 °C-102.9 °C), without temperature rise outside of the vertebrae (38.2 °C ± 1.5 °C). Mobility, neurological responses, and behavior were normal, consistent with preprocedural examination. Magnetic resonance imaging best visualized ablation at Day 14. Histology revealed comprehensive homogeneous coagulative necrosis with little peripheral sign of repair. CONCLUSIONS The Bone Coil RFA device created large intravertebral ablation volumes with no neurologic sequelae. Radiofrequency thermal ablation (clearly distinguished from the much smaller effects arising from core drilling) corresponded to the homogeneous necrosis visible on histology.
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Affiliation(s)
- Padina S Pezeshki
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Sean R Davidson
- Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Margarete K Akens
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Kieran Murphy
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Claire McCann
- Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Michael Sherar
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Cari M Whyne
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Albert J M Yee
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada.
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Pezeshki PS, Davidson S, Murphy K, McCann C, Slodkowska E, Sherar M, Yee AJ, Whyne CM. Comparison of the effect of two different bone-targeted radiofrequency ablation (RFA) systems alone and in combination with percutaneous vertebroplasty (PVP) on the biomechanical stability of the metastatic spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26206290 DOI: 10.1007/s00586-015-4057-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) and percutaneous vertebroplasty (PVP) are used independently and in combination to treat metastatically involved vertebrae with the aim of relieving pain, reducing tumour burden and providing bony mechanical stabilization. PURPOSE The aim of this work was to characterize the effect of two bone-targeted RFA devices, alone and in combination with PVP, to improve strength and mechanical stability in vertebrae with osteolytic metastatic disease. METHODS Simulated spinal metastases (n = 12) were treated with one of two bone-targeted RFA devices (bipolar cooled or bone coil RF electrodes), followed by PVP. Under axial compressive loading, spinal canal narrowing was measured in the intact specimen, after tumour simulation, post-RFA and post-PVP. RESULTS RFA alone resulted in successful tumour shrinkage and cavitation, but further increased canal narrowing under loading. RFA combined with PVP significantly reduced posterior wall stability in samples where sufficient tumour shrinkage and cavitation were coupled with a pattern of cement deposition which extended to posterior vertebral body. CONCLUSIONS RFA combined with cement deposition in the posterior vertebral body demonstrates significantly more stable vertebrae under axial loading.
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Affiliation(s)
- Padina S Pezeshki
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
- Sunnybrook Research Institute, 2075 Bayview Ave., Room S620, Toronto, ON, M4N 3M5, Canada
| | - Sean Davidson
- Techna Institute, University Health Network, 124-100 College Street, Toronto, ON, M5G 1P5, Canada
| | - Kieran Murphy
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
- Techna Institute, University Health Network, 124-100 College Street, Toronto, ON, M5G 1P5, Canada
| | - Claire McCann
- Sunnybrook Research Institute, 2075 Bayview Ave., Room S620, Toronto, ON, M4N 3M5, Canada
| | - Elzbieta Slodkowska
- Sunnybrook Research Institute, 2075 Bayview Ave., Room S620, Toronto, ON, M4N 3M5, Canada
| | - Michael Sherar
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
- Techna Institute, University Health Network, 124-100 College Street, Toronto, ON, M5G 1P5, Canada
| | - Albert Jm Yee
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
- Sunnybrook Research Institute, 2075 Bayview Ave., Room S620, Toronto, ON, M4N 3M5, Canada
| | - Cari M Whyne
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.
- Sunnybrook Research Institute, 2075 Bayview Ave., Room S620, Toronto, ON, M4N 3M5, Canada.
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A novel treatment for bone lesions of multifocal epithelioid sarcoma-like hemangioendothelioma. Skeletal Radiol 2015; 44:1013-9. [PMID: 25564226 DOI: 10.1007/s00256-014-2089-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/07/2014] [Accepted: 12/10/2014] [Indexed: 02/02/2023]
Abstract
Epithelioid sarcoma-like hemangioendothelioma (ES-H) is a rare, indolent vascular neoplasm with characteristics similar to epithelioid sarcoma. It typically affects young males who present with skin and subcutaneous lesions in the extremities. Bone lesions, occurring in approximately 20% of patients, are often multifocal, seen in conjunction with soft tissue lesions, and usually found in bones of the lower extremities. This report details the case of a 20-year-old male who presented with a 1-year history of painful skin lesions on his left lower extremity. Staging studies revealed bone lesions in the cuboid and calcaneus. Bone and soft tissue pathology was consistent with ES-H. The soft tissue lesions were treated with wide excision and the bony lesions with radiofrequency ablation (RFA). The patient had no evidence of recurrence at the 2-year follow-up. Treatment of ES-H typically consists of wide excision of all soft tissue lesions and possible adjuvant radiation therapy. Management of bony lesions has included marginal excision, wide excision, amputation, chemotherapy, observation, or a combination of these modalities. ES-H has the potential for distant metastases. There is no consensus regarding the appropriate treatment of multifocal epithelioid sarcoma-like hemangioendothelioma involving bone. A potential treatment strategy of wide excision of soft tissue lesions and RFA of bone lesions is proposed.
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Liu X, Yang Z, Xie L, Yuan Z, Ren M, Han L. Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases. Biomed Rep 2015; 3:621-625. [PMID: 26405535 DOI: 10.3892/br.2015.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/22/2015] [Indexed: 12/16/2022] Open
Abstract
Spinal metastasis is one of the commonly observed complications in the advanced stages of cancer patients, and is a serious threat to human life and health. Malignant tumor invasion usually leads to defects in the posterior margins of the vertebral body, which caused significant cancer pains to patients and increased the risk of surgery. Currently, minimally invasive treatments of vertebral defects caused by spinal metastases include percutaneous vertebroplasty (PVP) combined with radiofrequency ablation and PVP combined with 125I seed implantation. These minimally invasive techniques have particular superiority to control pain in patients with spinal metastases, improve nerve function, reduce the incidence of fractures and surgical risk, and improve the quality of life. The present study reviewed the progress in clinical research on vertebral defects caused by spinal metastases, and the mechanisms and minimally invasive treatment.
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Affiliation(s)
- Xuefeng Liu
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Zuozhang Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Lin Xie
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Zongqin Yuan
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Mingyan Ren
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Lei Han
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
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Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture. Cardiovasc Intervent Radiol 2015; 39:74-80. [PMID: 26071108 DOI: 10.1007/s00270-015-1151-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture. MATERIALS AND METHODS Thirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure. RESULTS In all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients' walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites. CONCLUSION Our results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.
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Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital "A. Businco", Regional Referral Center for Oncologic Diseases, 09100, Cagliari, Italy.
| | - Barbara Sotgia
- Department of Oncological Radiology, Oncological Hospital "A. Businco", Regional Referral Center for Oncological Diseases, 09100, Cagliari, Italy.
| | - Rosa Maria Fele
- Department of Oncological Radiology, Oncological Hospital "A. Businco", Regional Referral Center for Oncological Diseases, 09100, Cagliari, Italy.
| | - Nicola Ballicu
- Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital "A. Businco", Regional Referral Center for Oncologic Diseases, 09100, Cagliari, Italy.
| | - Luca Melis
- Department of Oncological Radiology, Oncological Hospital "A. Businco", Regional Referral Center for Oncological Diseases, 09100, Cagliari, Italy.
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Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur. Cardiovasc Intervent Radiol 2015; 39:81-9. [PMID: 26044668 DOI: 10.1007/s00270-015-1133-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur. METHODS A total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15-45 ml cement was injected into the femur lesion. RESULTS The overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05). CONCLUSION PCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.
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Liu W, Zhou S, Wang S. Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases. Oncol Lett 2015; 9:2775-2780. [PMID: 26137145 DOI: 10.3892/ol.2015.3145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 01/29/2015] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to explore the clinical implications of percutaneous vertebroplasty (PVP) in the treatment of multiple thoracic metastases. A total of 104 involved vertebrae of 28 patients with multiple thoracic metastases underwent PVP and the injection of bone cement. The pain relief rate and activity of daily life were assessed, and the morphological changes of the involved vertebral bodies and the invasiveness of the intraspinal tumor were also observed at 1 week, and 3, 6 and 12 months post-surgery, respectively. The pain relief rate increased at each time-point following PVP. The quality of life scores were also significantly higher than the pre-operative scores. After 12 months of follow-up, the post-operative heights of the anterior border, center and posterior border of the vertebral bodies were not noted to be statistically different from those prior to PVP (P>0.05). The present study concluded that PVP has a good analgesic effect on multiple thoracic metastases. PVP not only improves the quality of life of patients significantly, but also prevents further vertebral collapse and the invasiveness of intraspinal tumors, avoiding the nerve dysfunction caused by spinal cord compression.
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Affiliation(s)
- Wenhua Liu
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Shijun Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Shaofeng Wang
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
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Scott SJ, Salgaonkar V, Prakash P, Burdette EC, Diederich CJ. Interstitial ultrasound ablation of vertebral and paraspinal tumours: parametric and patient-specific simulations. Int J Hyperthermia 2015; 30:228-44. [PMID: 25017322 DOI: 10.3109/02656736.2014.915992] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Theoretical parametric and patient-specific models are applied to assess the feasibility of interstitial ultrasound ablation of tumours in and near the spine and to identify potential treatment delivery strategies. METHODS 3D patient-specific finite element models (n = 11) of interstitial ultrasound ablation of tumours associated with the spine were generated. Gaseous nerve insulation and various applicator configurations, frequencies (3 and 7 MHz), placement trajectories, and tumour locations were simulated. Parametric studies with multilayered models investigated the impacts of tumour attenuation, tumour dimension, and the thickness of bone insulating critical structures. Temperature and thermal dose were calculated to define ablation (>240 equivalent minutes at 43 °C (EM43 °C)) and safety margins (<45 °C and <6 EM43 °C), and to determine performance and required delivery parameters. RESULTS Osteolytic tumours (≤44 mm) encapsulated by bone could be successfully ablated with 7 MHz interstitial ultrasound (8.1-16.6 W/cm(2), 120-5900 J, 0.4-15 min). Ablation of tumours (94.6-100% volumetric) 0-14.5 mm from the spinal canal was achieved within 3-15 min without damaging critical nerves. 3 MHz devices provided faster ablation (390 versus 930 s) of an 18 mm diameter osteoblastic (high bone content) volume than 7 MHz devices. Critical anatomy in proximity to the tumour could be protected by selection of appropriate applicator configurations, active sectors, and applied power schemas, and through gaseous insulation. Preferential ultrasound absorption at bone surfaces facilitated faster, more effective ablations in osteolytic tumours and provided isolation of ablative energies and temperatures. CONCLUSIONS Parametric and patient-specific studies demonstrated the feasibility and potential advantages of interstitial ultrasound ablation treatment of paraspinal and osteolytic vertebral tumours.
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Affiliation(s)
- Serena J Scott
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California , San Francisco , California
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Radiologie interventionnelle des métastases osseuses. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Saumet L, Deschamps F, Marec-Berard P, Gaspar N, Corradini N, Petit P, Sirvent N, Brugières L. Radiofrequency ablation of metastases from osteosarcoma in patients under 25 years: the SCFE experience. Pediatr Hematol Oncol 2015; 32:41-9. [PMID: 25007012 DOI: 10.3109/08880018.2014.926469] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has demonstrated its effectiveness in controlling metastases measuring less than 3 cm in several adult malignancies but not yet in osteosarcoma. We report our experience of RFA in the treatment of metastases in adolescents and young adults (AYA) with osteosarcoma. PROCEDURE Sixteen patients treated for osteosarcoma in French Society of Childhood Cancer centers had undergone an RFA procedure between 2006 and 2012. RESULTS Thirteen sessions were performed in 10 patients to treat 22 lung metastases. Seven patients were in complete remission at last follow up (range 19-51 months; median, 24 months after RFA). None had a recurrence at RFA sites. We report three cases each of hemoptysis and pneumothorax. Eight sessions were performed in seven patients to treat bone lesions. PROCEDURE was intended as: curative for a small metastatic lesion (n = 3, all in remission more than 3 years after); local control of small bone lesions in multi-metastatic diseases (n = 3); analgesia (n = 1). Complications included one first-degree burn, one fracture, and one soft tissue infection. CONCLUSIONS RFA is feasible in AYA with osteosarcoma. It efficiently achieved local control of small peripheral lung metastases. Its role in the curative care of small secondary bone lesions remains to be confirmed.
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Affiliation(s)
- L Saumet
- 1Department of Paediatric Oncology, Hôpital Arnaud de Villeneuve, Montpellier, France
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Tian QH, Wu CG, Gu YF, He CJ, Li MH, Cheng YD. Combination Radiofrequency Ablation and Percutaneous Osteoplasty for Palliative Treatment of Painful Extraspinal Bone Metastasis: A Single-Center Experience. J Vasc Interv Radiol 2014; 25:1094-100. [DOI: 10.1016/j.jvir.2014.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/15/2014] [Accepted: 03/16/2014] [Indexed: 11/30/2022] Open
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Alemann G, Kastler A, Barbé DA, Aubry S, Kastler B. Treatment of painful extraspinal bone metastases with percutaneous bipolar radiofrequency under local anesthesia: feasibility and efficacy in twenty-eight cases. J Palliat Med 2014; 17:947-52. [PMID: 24841971 DOI: 10.1089/jpm.2013.0531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To retrospectively assess the feasibility and efficacy of bipolar radiofrequency ablation (RFA) of extraspinal osseous neoplasms performed under local anesthesia. METHODS AND MATERIALS Twenty-eight patients (21 males, 7 females; mean age, 61.2 years) underwent RFA under local anesthesia between 2005 and 2012. All included patients suffered from painful osseous metastases refractory to previous medication; all presented with end-stage neoplasms. RFA was performed under computed tomography (CT) guidance with bipolar radiofrequency probes. All procedures were performed under local anesthesia (lidocaine-ropivacaine) and nitrous oxide ventilation. Intravenous injection of paracetamol was performed throughout the procedure with or without intravenous injection of nalbuphin. Tolerance of procedure was recorded. Pain efficacy was evaluated on visual anologue scale (VAS) scores at day 7, 1 month, and at 6 months after the procedure. RESULTS Technical success rate was 100%. The procedure was considered not painful in 4 cases and tolerable in 20 cases. Average procedural time was 23.1 minutes. Mean VAS score prior to RFA was 8.1/10. Significant decrease of pain was noted at day 7 (3.3/10, p<0.001, n=27), 1 month (3.8/10, p<0.001, n=27), and 6 months (4.5/10, p<0.001, n=13). No complications were noted. CONCLUSION Bipolar RFA of osseous metastases is a safe and effective treatment for refractory bone metastases. Its feasibility under local anesthesia should broaden the indications.
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Affiliation(s)
- Guillaume Alemann
- 1 Radiology and Interventional Pain Unit, University Hospital , Besançon, France
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Kastler A, Alnassan H, Pereira PL, Alemann G, Barbé DA, Aubry S, Tiberghien F, Kastler B. Analgesic Effects of Microwave Ablation of Bone and Soft Tissue Tumors Under Local Anesthesia. PAIN MEDICINE 2013; 14:1873-81. [DOI: 10.1111/pme.12242] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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