Radiofrequency ablation and balloon kyphoplasty for palliation of painful spinal metastases

Combined Radiofrequency Ablation and Balloon Kyphoplasty Following Radiation Therapy for Spinal Metastases and Associated Pain. A Case Report

Pain Management Case Reports ◽

10.36076/pmcr.2021.5.241 ◽

2021 ◽

pp. 241-245

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Back Pain ◽

Case Report ◽

Radiofrequency Ablation ◽

Radiation Treatment ◽

Spinal Metastasis ◽

Spinal Metastases ◽

Bone Cancer ◽

Balloon Kyphoplasty

BACKGROUND: The spine is a common area of metastasis to the bone. Radiation therapy has been the standard treatment for focal metastatic spine tumors, and although it has shown an ability to reduce pain, it is not curative for all patients and can negatively impact a patient’s quality of life. Treating spinal metastatic pain with the use of radiofrequency ablation (RFA) in combination with kyphoplasty has been shown to be safe and effective in the treatment of spinal metastatic pain. We present a case of using balloon kyphoplasty with OsteoCoolTM RFA for treating both spinal metastasis and pain. CASE REPORT: A 65-year-old man with a history of prostate cancer presented with metastasis to the L1 vertebral body and chronic low back pain refractory to multimodal pharmacologic treatment. He previously had radiation therapy for this bone metastasis and was maintained on enzalutamide for prostate cancer with decreasing prostate-specific antigens followed by hematology/oncology. Balloon kyphoplasty with OsteoCool RFA was performed with resolution of the patient’s pain as well as the tumor metastasis. CONCLUSION: To our knowledge, there is no available literature discussing the administration of all the above (i.e., RFA, kyphoplasty/vertebroplasty, radiation) together, the sequence in which they are performed, the benefits and consequences of the treatment sequence, the time to and level of pain relief, and differences in radiation exposure. The results of this case provide a clinical rationale for performing RFA and kyphoplasty prior to radiation treatment, while further studies should be conducted to further elucidate the best administration of this treatment. KEY WORDS: Back pain, bone, cancer, kyphoplasty, metastasis, radiation, radiofrequency ablation, vertebroplasty

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Radiofrequency Ablation and Radiation Therapy Improve Local Control in Spinal Metastases Compared to Radiofrequency Ablation Alone

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118819460 ◽

2018 ◽

Vol 36 (5) ◽

pp. 417-422 ◽

Cited By ~ 5

Author(s):

Kavitha M. Prezzano ◽

Dheerendra Prasad ◽

Gregory M. Hermann ◽

Ahmed N. Belal ◽

Ronald A. Alberico

Keyword(s):

Radiation Therapy ◽

Radiofrequency Ablation ◽

Local Control ◽

Combined Treatment ◽

Spinal Metastases ◽

Significant Benefit ◽

Unequal Distribution ◽

Common Location ◽

Significant Difference

Purpose: The spinal column is the most common location for osseous metastases and is associated with pain and decreased quality of life. This study evaluated combined radiofrequency ablation (RFA) with radiation therapy (RT) compared to RFA alone for improving pain and local control. Methods: This was a single-institution retrospective review of patients who underwent RFA of spinal metastases between 2016 and 2017, with or without RT to the same vertebral level. Pain was measured with visual analog scale at initial presentation and at 3 and 12 weeks of follow-up. Local failure (LF), distant failure, and overall survival (OS) were compared and Kaplan-Meier statistics were calculated. Results: Twenty-six patients with 28 spinal metastases were treated with RFA. Ten patients with 11 metastases were treated with RFA + RT. More patients with lung primaries were treated with RFA alone and more patients with breast primaries were treated with combination RFA+RT. There was no significant difference in pain scores between groups ( P = .96). At a median follow-up of 8.2 months, LF was noted in 8 of 17 metastases treated with RFA alone compared to 1 of 11 metastases treated with RFA+RT ( P = .049). There was a significant benefit in time to LF favoring RFA+RT ( P = .02) and a significant benefit in OS ( P = .0045). Conclusion: This study demonstrates a benefit in local control with RFA+RT versus RFA alone. Palliation of pain was effective using both regimens. This study was limited by a nearly unequal distribution of primary tumor histologies between groups. Literature regarding combined treatment of RFA and RT for spinal metastases is scarce and prospective protocols are warranted.

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Pain palliation and radiographic local control of spinal metastases with percutaneous radiofrequency ablation and vertebral augmentation

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2015.12.448 ◽

2016 ◽

Vol 27 (3) ◽

pp. S173

Author(s):

A. Wallace ◽

A. Tomasian ◽

T. Greenwood ◽

D. Vaswani ◽

R. Vyhmeister ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Local Control ◽

Spinal Metastases ◽

Vertebral Augmentation ◽

Pain Palliation ◽

Percutaneous Radiofrequency Ablation

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Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis

Coluna/Columna ◽

10.1590/s1808-18512014130300433 ◽

2014 ◽

Vol 13 (3) ◽

pp. 235-238

Author(s):

Carlos Fernando Pereira da Silva Herrero ◽

Mario Bressan Neto ◽

Carlos Eduardo Sargi Godoy ◽

Vitor Rodrigues Fornazari ◽

Lilian Maria Pacola ◽

...

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Vertebral Body ◽

Postoperative Period ◽

Spinal Metastases ◽

Balloon Kyphoplasty ◽

Vertebral Metastases ◽

Minimally Invasive Surgical ◽

Minimally Invasive Surgical Treatment ◽

The Mean

OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS) and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36%) males and 14 (64%) females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases.

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The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases

Current Oncology ◽

10.3390/curroncol28050340 ◽

2021 ◽

Vol 28 (5) ◽

pp. 4004-4015

Author(s):

Claudio Pusceddu ◽

Davide De Francesco ◽

Luca Melis ◽

Nicola Ballicu ◽

Alessandro Fancellu

Keyword(s):

Radiofrequency Ablation ◽

Pain Relief ◽

Spinal Metastases ◽

Local Tumor Control ◽

Tumor Control ◽

Vertebral Augmentation ◽

Local Tumor ◽

Metastatic Lesions ◽

The Mean

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.

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Delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation: Case report with histopathologic-MRI correlation

Interventional Neuroradiology ◽

10.1177/1591019915609131 ◽

2015 ◽

Vol 21 (6) ◽

pp. 742-749 ◽

Cited By ~ 6

Author(s):

Adam N Wallace ◽

Ross Vyhmeister ◽

Andy C Hsi ◽

Clifford G Robinson ◽

Randy O Chang ◽

...

Keyword(s):

Case Report ◽

Radiofrequency Ablation ◽

Stereotactic Radiosurgery ◽

Vertebral Body ◽

Spinal Metastases ◽

Imaging Findings ◽

Pain Palliation ◽

Percutaneous Radiofrequency Ablation ◽

Emerging Therapies

Stereotactic radiosurgery and percutaneous radiofrequency ablation are emerging therapies for pain palliation and local control of spinal metastases. However, the post-treatment imaging findings are not well characterized and the risk of long-term complications is unknown. We present the case of a 46-year-old woman with delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation of a painful lumbar metastasis. Histopathologic-MRI correlation confirmed osteonecrosis as the underlying etiology and demonstrated that treatment-induced vascular fibrosis and tumor progression can have identical imaging appearances.

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Targeted radiofrequency ablation of spinal metastases that have received prior radiation therapy and in radiation resistant tumors: pain palliation, local tumor control, and patient outcomes

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2014.12.059 ◽

2015 ◽

Vol 26 (2) ◽

pp. S19-S20

Author(s):

T. Greenwood ◽

T. Hillen ◽

M.V. Friedman ◽

J. Jennings

Keyword(s):

Radiation Therapy ◽

Radiofrequency Ablation ◽

Patient Outcomes ◽

Spinal Metastases ◽

Local Tumor Control ◽

Tumor Control ◽

Pain Palliation ◽

Local Tumor ◽

Radiation Resistant

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Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

BMC Neurology ◽

10.1186/s12883-020-01998-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nanning Lv ◽

Rui Geng ◽

Feng Ling ◽

Zhangzhe Zhou ◽

Mingming Liu

Keyword(s):

Radiofrequency Ablation ◽

Bone Cement ◽

Recurrence Rate ◽

Tumor Recurrence ◽

Spinal Metastases ◽

Efficacy And Safety ◽

Significant Difference ◽

Group A ◽

Group B ◽

Tumor Recurrence Rate

Abstract Background To investigate the clinical efficacy and safety of bone cement combined with radiofrequency ablation (RFA) in the treatment of spinal metastases. Methods The medical records of patients with spinal metastatic tumor admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. Based on different surgical methods, the patients were divided into groups A (treated with RFA combined with bone cement) and B (treated with bone cement only). Group A included 35 patients with 47 segments of diseased vertebral bodies. Group B consisted of 52 patients with 78 vertebral segments. Pain, quality of life score, vertebra height, bone cement leakage, postoperative tumor recurrence, and complications were assessed 3 days and 1 and 6 months after surgery. Results All the patients had smooth operation without paraplegia, spinal cord injury, and perioperative death. Visual analogue scales (VAS) and Oswestry Disability Index (ODI) scores of the two groups significantly improved 3 days and 1 month after surgery compared with those before surgery (P < 0.05), but no significant difference was observed between the two groups (P > 0.05). Six months after surgery, the VAS and ODI scores of patients in group A were lower than those in group B, with statistically significant differences (P < 0.05). The postoperative vertebral body height of the two groups significantly increased compared with that before surgery, and the difference was statistically significant (P < 0.05). Meanwhile, no significant difference was observed between the two groups (P > 0.05). Postoperative bone cement permeability in group A was 6.4%, and postoperative tumor recurrence rate was 11.4%. The permeability of bone cement in group B was 20.5%, and the tumor recurrence rate was 30.8%. The bone cement permeability and tumor recurrence rate in group A were lower than those in group B, with statistically significant differences (P < 0.05). Conclusions Bone cement combined with RFA for the treatment of spinal metastases can achieve good efficacy, desirable analgesic effect, low incidence of complications, small surgical trauma, and high safety. The proposed method has the value of clinical popularization and application.

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