Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update

2017 ◽  
Vol 18 (12) ◽  
Author(s):  
Ning Mao Kam ◽  
Julian Maingard ◽  
Hong Kuan Kok ◽  
Dinesh Ranatunga ◽  
Duncan Brooks ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Spinal Metastases ◽  
Vertebral Augmentation

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

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.

scholarly journals Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation

2015 ◽  
Vol 37 (4) ◽  
pp. 759-765 ◽  
Author(s):  
A.N. Wallace ◽  
A. Tomasian ◽  
D. Vaswani ◽  
R. Vyhmeister ◽  
R.O. Chang ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Local Control ◽  
Spinal Metastases ◽  
Vertebral Augmentation ◽  
Percutaneous Radiofrequency Ablation

Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases

2015 ◽  
Vol 124 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Adam N. Wallace ◽  
Taylor J. Greenwood ◽  
Jack W. Jennings
Keyword(s):  
Radiofrequency Ablation ◽  
Spinal Metastases ◽  
Vertebral Augmentation

scholarly journals Combined Ablation and Radiation Therapy of Spinal Metastases: A Novel Multimodality Treatment Approach

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. 573-581
Author(s):  
Taylor J. Greenwood
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Radiofrequency Ablation ◽  
Spinal Metastases ◽  
Percutaneous Ablation ◽  
Vertebral Augmentation ◽  
Single Institution ◽  
Safety And Efficacy ◽  
Spine Metastases ◽  
Radiation Resistant

Background: Radiation therapy (RT) is the current gold standard for palliation of painful vertebral metastases. However, other percutaneous modalities such as radiofrequency ablation (RFA), cryoablation, and vertebral augmentation have also been shown to be effective in alleviating symptoms. Combined RT and ablation may be more effective than either therapy alone in palliating painful metastatic disease to the spine. Objective: To evaluate the safety and efficacy of combined ablation, either RFA or cryoablation, and RT in the treatment of spinal metastases. Study Design: Retrospective study. Setting: This is a retrospective study at a single institution. Methods: Medical records of all patients who underwent ablation of spine lesions at a single institution between March 2012 and June 2014 were reviewed; patients treated with both RT and either RFA or cryoablation concurrently were identified. Pain scores before and after RFA were measured with the numerical rating scale (NRS) (0 – 10 point scale) and compared. Procedural complications, changes in general activity level, and pain medication usage after ablation were also recorded. When available, follow-up imaging was evaluated for evidence of residual or recurrent disease. Results: Twenty-one patients with 36 spine metastases were treated with RT and percutaneous ablation concurrently; either RFA (21/22) or cryoablation (1/22). One patient received 2 separate RFA treatments. Overall, mean worst pain score (8.0, SD = 2.3) significantly decreased at both one week (4.3, SD = 3.1; P < .02) and 4 weeks (2.9, SD = 3.3; P < .0003). Temporary postprocedural radicular pain occurred after one RFA treatment (4.5%; 1/22). Seven patients had radiation resistant tumors (renal cell, melanoma, or sarcoma). Post-procedural imaging (median 6 months; range 2 – 27 months) showed stable treated disease in 12/13 treatments at 3 months and 10/10 at 6 months. Limitations: The therapeutic effect of vertebral augmentation versus percutaneous ablation cannot be separated in this retrospective study. Radiation treatment protocols were variable and included both stereotactic body and conventional RT which may have different safety and efficacy profiles. Conclusion: Percutaneous ablation and concurrent RT is safe and effective in palliating painful spinal metastases and can be effective in those who have radiation resistant tumor histology. Key words: Interventional spine oncology, pain, percuataneous ablation, radiofrequency ablation, cryoablation, radiation therapy, spine metastases, vertebroplasty

Back Pain: It’s Not Always Arthritis

2018 ◽  
Author(s):  
Tariq M. Malik
Keyword(s):  
Back Pain ◽  
Physical Examination ◽  
Spinal Metastases ◽  
Spinal Pain ◽  
Primary Treatment ◽  
Spinal Tumors ◽  
Vertebral Augmentation ◽  
Augmentation Therapy ◽  
Patient History ◽  
Pain Evaluation

Back pain is prevalent in adults, and most often its cause is nonspecific and benign. Imaging and interventions are not always helpful and they are generally expensive and low yield. However, in about 10% or fewer cases, a specific etiology is found. A patient history, physical examination, and testing are the methods for finding the cause. Back pain from malignancy must also be considered. Prolonged survival from better chemotherapy has increased the incidence of metastases to bone, especially the spine. Common sources of spinal metastases are cancers of the prostate, kidneys, thyroid, breast, and lungs. The primary treatment is to address the malignancy. Pain from spinal tumors can be treated with chemotherapy, radiotherapy, radiofrequency, or vertebral augmentation therapy. The chapter reviews the epidemiology of spinal cancer pain, evaluation of malignant spinal pain, and what the interventional pain physician can offer patients to alleviate their pain.

Percutaneous vertebral augmentation procedures in the management of spinal metastases

2020 ◽  
Vol 475 ◽  
pp. 136-142 ◽  
Author(s):  
Hao-ran Zhang ◽  
Ming-you Xu ◽  
Xiong-gang Yang ◽  
Rui-qi Qiao ◽  
Ji-kai Li ◽  
...  
Keyword(s):  
Spinal Metastases ◽  
Vertebral Augmentation

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

2018 ◽  
Vol 36 (5) ◽  
pp. 417-422 ◽  
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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