scholarly journals (OA17) Radiofrequency Ablation and Radiation Therapy Improve Local Control in Spinal Metastases Compared to Radiofrequency Ablation Alone

2018 ◽  
Vol 101 (2) ◽  
pp. e7-e8
Author(s):  
Kavitha Prezzano ◽  
Author, Dheerendra Prasad, MD ◽  
Ahmed N. Belal ◽  
Ronald A. Alberico
Keyword(s):  
Radiation Therapy ◽  
Radiofrequency Ablation ◽  
Local Control ◽  
Spinal Metastases

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.

Spine stereotactic radiosurgery as a promising modality in patients with metastatic hepatocellular and cholangiocarcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13551-e13551
Author(s):  
Olsi Gjyshi ◽  
Ahmed Omar Kaseb ◽  
Amol J. Ghia
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiation Therapy ◽  
Viral Hepatitis ◽  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Cox Regression ◽  
Early Stage ◽  
Spinal Metastases ◽  
High Dose ◽  
Cox Regression Analysis

e13551 Background: While stereotactic body radiation therapy (SBRT), a form of high-dose rate radiation therapy, is often used in the local management of early-stage hepatocellular carcinoma (HCC), its role in managing metastatic hepatobiliary malignancies is currently unclear. Here, we investigate the role of spine stereotactic radiosurgery (SSRS), a form of SBRT that targets spinal metastases, in the management of late-stage HCC or cholangiocarcinoma. Methods: We retrospectively reviewed a total of 28 patients with 43 HCC or cholangiocarcinoma metastases treated with SSRS between 2004 and 2017 at our institution. We used Kaplan-Meier curves to estimate overall survival (OS) and local control (LC), and Cox regression analysis to identify potential predictive factors of the two. Results: The median patient age was 63 (range 28 to 78) years old. Four patients had a histology-proven diagnosis of metastatic cholangiocarcinoma, while 39 had hepatocellular carcinoma. Of the patients with HCC, 47% had predisposing viral hepatitis, while 53% had either non-alcoholic steatohepatitis (NASH) or no known predisposing factors. Twenty-nine cases were treated with 24Gy in 1 fraction, 11 with 27Gy in 3 fractions, 2 with 18Gy in 2 fractions, and 1 with 30Gy in 5 fractions. The 1-year actuarial OS and LC rates were 23% and 75%, respectively. The median OS was 6.3 months, while the median time to local failure was not reached. On univariate modeling, negative predictors of LC included history of prior RT to the site of metastasis (p < 0.005) and tumor volume > 60cc (p = 0.03), while biologic equivalent dose (BED) > 52Gy was the only positive predictive factor (p < 0.05). Presence of epidural disease, Bilsky grade, presence of viral hepatitis, or type histology were not predictors of LC (all p > 0.05). In patients who had pain or neurologic findings at presentation, 56% reported improvement in their symptoms on follow up. Three patients (11%) developed compression deformity and one patient (4%) developed radiation-induced neuritis. Conclusions: SSRS provides promising and durable local control in patients with metastatic hepatobiliary disease, and early intervention with high BED are necessary to ensure high level of local control, improvement in symptoms, and a low rate of long-term toxicity.

scholarly journals Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review

2017 ◽  
Vol 27 (4) ◽  
pp. 428-435 ◽  
Author(s):  
Sten Myrehaug ◽  
Arjun Sahgal ◽  
Motohiro Hayashi ◽  
Marc Levivier ◽  
Lijun Ma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radiation Therapy ◽  
Literature Review ◽  
Local Control ◽  
Systematic Literature Review ◽  
Stereotactic Body Radiation Therapy ◽  
Symptom Control ◽  
Spinal Metastases ◽  
Quality Data ◽  
Stereotactic Body Radiation

OBJECTIVESpinal metastases that recur after conventional palliative radiotherapy have historically been difficult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical efficacy and safety of spine SBRT specific to previously irradiated spinal metastases.METHODSA systematic literature review was conducted, which was specific to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT efficacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe?RESULTSThe initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low- or very low–quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%–90%). Improvement in patients’ pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%–22%) and radiation-induced myelopathy of 1.2%.CONCLUSIONSThis systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.

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

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

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

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

scholarly journals Radiation Therapy without Surgery for Spinal Metastases: Clinical Outcome and Prognostic Factors Analysis for Pain Control

2012 ◽  
Vol 2 (3) ◽  
pp. 137-141
Author(s):  
Akira Matsumura ◽  
Manabu Hoshi ◽  
Masatsugu Takami ◽  
Takahiko Tashiro ◽  
Hiroaki Nakamura
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Clinical Outcome ◽  
Pain Control ◽  
Spinal Metastases ◽  
Factors Analysis
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