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
Abstract No. 165 Radiofrequency ablation in combination with kyphoplasty for the treatment of painful spine metastases: evaluation of VAS pain scale
