Combined Microwave Ablation and Osteosynthesis for Long Bone Metastases

Background and Objectives: The purpose of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning for the treatment of fractures or impending fractures of long bone metastases. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Pain intensity was measured using a VAS score before and after treatment. CT or MRI were acquired at one month before and 1, 3, 6, 12 and 18 months after treatment. Results: All procedures were successfully completed without major complications. The level of pain was significantly reduced one month after treatment. For the patients with humerus metastases, the complete recovery of arm use took 8 weeks, while for the patients with femoral metastases the complete recovery of walking capacity took 11 weeks. The VAS score ranged from 7 (4–9) before treatment to 1.5 (0–2.5) after treatment. During a mid-term follow-up of 18 months (range 4–29 months), none of the patients showed tumor relapse or new fractures in the treated site. Two patients died due to tumor disease progression. Conclusion: Results of this preliminary study suggest that combined MWA and surgical osteosynthesis with locked nails is a safe and effective treatment for pathological fractures or malignant impending fractures of long bone metastases of the humerus, femur and tibia. Further analyses with larger cohorts are warranted to confirm these findings.

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Procollagen-I-propeptide and β-crosslaps are prognostic markers for pretherapeutic estimation of treatment success of combined radio- and bisphosphonate therapy in patients with bone metastases—A phase-II study

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9096 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9096-9096 ◽

Cited By ~ 1

Author(s):

W. Wagner ◽

A. Radmard ◽

M. Bach ◽

C. Loitsch ◽

M. G. Krukemeyer ◽

...

Keyword(s):

Prostate Cancer ◽

Pain Relief ◽

Bone Metastases ◽

Treatment Success ◽

Bisphosphonate Therapy ◽

Dose Fractionation ◽

Normal Range ◽

Before And After ◽

Breast And Prostate Cancer ◽

Painful Bone Metastases

9096 Background: Multiple painful bone metastases are a common problem in patients suffering from breast and prostate cancer. Side effects of morphines can impair quality of life. Pain reduction can also be achieved by radiotherapy combined with bisphosphonates; however, this treatment is not successful in all patients. Methods: 35 patients with breast and prostate cancer suffering from painful bone metastases (multiple metastases in 29 cases, solitary metastasis in 6 cases: were locally irradiated (30 - 40 Gy over 3 - 4 weeks, conventional dose fractionation). In addition they received a bisphosphonate therapy (zoledronate). Before and after radiotherapy procollagen-I- propeptide and β-crosslaps were measured as parameters for the intensity of bone metabolism. Results: 24 patients experienced complete pain relief, 10 patients partial pain relief and one patient noticed no effect of treatment. The values of procollagen-I-propeptide (normal range 19–102 μg/l) and β-crosslaps (normal range <= 1,0 μg/l) were correlated with treatment success. At pretherapeutical procollagen-I- propeptide levels above 190 μg/l, all patients became entirely free of pain. All patients with β-crosslaps values above 0.5 μg/l became equally free of pain, irrespective of the number of metastases and tumour entity. The mean levels of procollagen-I-propeptide as well as β-crosslaps correlate directly and without exception with analgesia, reduction of pain or persistency of pain as final results. No correlation concerning the values was found before and after therapy. Conclusion: Procollagen-I-propeptide as well as β-crosslaps measurements before the beginning of a radio- and bisphosphonate therapy due to painful bone metastases are an excellent prognostic parameter to predict the success of therapy. Where high initial values (procollagen-I-propeptide > 190 μg/l or β-crosslaps > 0.5 μg/l) were measured, complete analgesia was achieved through therapy. Despite this clinically clear statement, a statistical significance with a t-Test was not evaluable at the current collection of patient data. Therefore, 20 more patients were examined; the results are yet to come. No significant financial relationships to disclose.

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Comparison of three different radiation fractionation schedules in the palliation of painful bone metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9055 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9055-9055

Author(s):

Monica Malik ◽

Swapna Jilla ◽

Nanditha Sesikeran ◽

K. V. Jagannath Rao Naidu ◽

Suresh Pamidighantam ◽

...

Keyword(s):

Bone Metastases ◽

Pain Score ◽

Performance Status ◽

Response Rates ◽

Complete Response ◽

Analgesic Requirement ◽

Single Fraction ◽

Overall Response ◽

Painful Bone Metastases

9055 Background: The purpose of this study was to compare the efficacy of a single fraction versus two multifractionated regimens in the palliation of painful bone metastases. Methods: Patients with painful bone metastases were randomized into three groups. Group I received a dose of 8 Gy in a single fraction, Group II received 20 Gy in five fractions and Group III patients received 30 Gy in 10 fractions. Pain score, ECOG performance status and analgesic requirement were recorded at baseline and at 1, 4, 8 and 12 weeks following treatment. Pain score was recorded on a 5-point verbal rating scale from 0 (no pain) to 4 (extremely severe pain). Overall response was defined as decrease in pain score by at least one point. Complete response was defined as achieving a pain score of zero at any point during follow-up. Duration of overall response was defined as the time from initial response till return of pain to its baseline value. Results: 45 patients were included with 15 in each group. Median age was 55 years (range 29-78 years). 17(37.7%) had metastasis in pelvic bones; 17(37.7%) in the spine while the remainder in the appendicular bones. Overall response rates in Groups I, II and III at week 1 were 60%, 53.3% and 60% respectively (p=0.71). At 1 month, overall response rates were 71.4%, 73.3% and 73.3% (p=0.84) and at 3 months; 78.5%, 80% and 80% respectively (p=0.86). The rate of complete response in all the three groups was 20%. Improvement in performance status in Groups I, II and III was seen in 60%, 66% and 80% respectively (p=0.69). Analgesic usage decreased in 86%, 87% and 80% patients in groups I, II and III respectively (p=0.66). Out of the nine complete responders, two sustained the response for less than four weeks, four patients up to eight weeks and remaining three till the end of follow-up. There was no statistically significant difference in between the three arms among all the variables compared. Conclusions: All three groups showed equal efficacy in pain palliation, analgesic requirement, improvement in performance status and duration of response. In patients with very advanced disease and short life expectancy, where the treatment goal is to decrease pain, 8 Gy in single fraction is a convenient and cost effective schedule.

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Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome

10.21203/rs.2.17728/v2 ◽

2020 ◽

Author(s):

Ji-Bin Chen ◽

Dong Chen ◽

Ya-Ping Xiao ◽

Jian-Zhong Chang ◽

Te Li

Keyword(s):

Synovial Membrane ◽

Lysholm Score ◽

Compression Syndrome ◽

Vas Score ◽

Kujala Score ◽

Before And After ◽

Lateral Patella ◽

Improved Function ◽

Lateral Patellar Compression Syndrome

Abstract Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) either through or outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS).Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR either through or outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, synovial membrane was retained. In the through synovial membrane (TSM) group,The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared.Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery ( P <0.001), but these observed targets before surgery and at the last follow-up between the two groups were compared with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group ( P =0.024).Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group.

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Preoperative Percutaneous Microwave Ablation of Long Bone Metastases Using a Parallel Medullary Approach for Reduction of Operative Blood Loss

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.03.004 ◽

2017 ◽

Vol 28 (7) ◽

pp. 1069-1071 ◽

Cited By ~ 1

Author(s):

Joshua Cornman-Homonoff ◽

Zoe A. Miller ◽

John Smirniotopoulos ◽

Benjamin J. May ◽

Ronald S. Winokur ◽

...

Keyword(s):

Blood Loss ◽

Bone Metastases ◽

Microwave Ablation ◽

Long Bone ◽

Operative Blood Loss ◽

Percutaneous Microwave Ablation

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All-Inside Arthroscopic Cancellous Allograft for the Large Cystic Osteochondral Defect of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00203 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0020

Author(s):

Shi-Ming Feng

Keyword(s):

Osteochondral Defect ◽

Functional Score ◽

Osteochondral Defects ◽

Vas Score ◽

Before And After ◽

Effective Option ◽

Pain State ◽

American Orthopaedic ◽

Cancellous Allograft

Category: Arthroscopy; Sports; Trauma Introduction/Purpose: The purpose of this study was to evaluate the surgical technique and long-term clinical outcomes of all- inside arthroscopic treatment for large cystic osteochondral defect of the talus with the use of cancellous allograft. Methods: Eight patients admitted from January 2016 to October 2018 by our hospital for large cystic osteochondral defect of the talus was retrospectively analyzed with their complete follow-up data. The subjects consisted of 5 males and 3 females, aged between 27 to 50 years, and with an average age of 34.2 years. All of these cystic osteochondral defects were larger than 15 mm in diameter, sized 1.3cm3 to 5.2cm3. The visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Karlsson Ankle Functional Score (KAFS) and subjective satisfaction survey rating were obtained. CT scan and magnetic resonance imaging of the ankle were obtained before and after surgery. Results: All incisions were healed in the first stage, and no complications such as nerve, blood vessel and tendon injuries occurred. All patients were available for follow-up at a mean of 26.2 months (range, 18 to 48 months). By the last follow-up, the postoperatively AOFAS 、 KAFS scores were 86.5 and 84.2 compared with 60.8 and 59.3 preoperatively, respectively. And the mean VAS score decreased from 6.4 preoperatively to 1.1. The range of motion of the ankle joint was normal and returned to the pre-pain state for these patients. Six patients rated their result as excellent, 2 as good and none as fair. Conclusion: All-inside arthroscopic cancellous allograft was an effective option for the treatment of large cystic talus osteochondral defects.

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The effect of nurse-led pain education of patients with painful bone metastases on pain and quality of life: A multicenter randomized trial.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.203 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 203-203

Author(s):

Jenske I. Geerling ◽

Natasja Raijmakers ◽

Veronique E.M. Mul ◽

Ellen JM de Nijs ◽

Marianne A Oudhof ◽

...

Keyword(s):

Quality Of Life ◽

Bone Metastases ◽

Pain Intensity ◽

Secondary Outcome ◽

Pain Education ◽

Eortc Qlq ◽

Painful Bone Metastases ◽

Short Schedule

203 Background: Radiotherapy (RT) is an effective treatment for painful bone metastases, although pain is not always sufficiently controlled. Pain management education may improve patient empowerment and, consequently, reduce pain intensity. The effect of nurse-led education (NLE) in patients undergoing RT for painful bone metastases was investigated as compared to care as usual (CAU). Primary endpoint was pain intensity at 12 weeks, secondary outcome was quality of life (QoL). Methods: In this multicentre, randomised phase 3 study, patients referred for short schedule RT, with uncontrolled pain (a score of ≥5 on a 0-10 numeric rating scale (NRS)), were randomised between NLE or CAU before start of RT. The NLE consisted of a structured interview including assessment of pain knowledge, verbal and written education on all aspects of pain and follow-up phone calls at 1, 4, 8 & 12 weeks to address pain-related questions. Patients in CAU received leaflets on RT, cancer pain and opioid use. Patient characteristics were assessed at baseline. Pain intensity and QoL were evaluated with the Brief Pain Inventory, EORTC QLQ-C15-PAL and EORTC QLQ-BM22 at baseline, and week 1, 4, 8 & 12. Power calculation showed that there were 89 patients per arm needed to detect a 10% difference in number of patients with a NRS < 5 at 12 weeks(1-sided α = 0.05; β 0.8). Results: Between May 2011-April 2016, 354 patients were randomised (176 NLE, 178 CAU), 38 were excluded (30 NRS < 5 at baseline, 7 no short schedule RT, 1 missing informed consent). At twelve weeks, 185 (NLE 95) had completed follow-up (72 stopped filling out questionnaires, 59 died prematurely). Baseline characteristics were similar in both groups; mean age 65 years, 56% men. At week 12, more patients in NLE than in CAU had controlled pain (NRS < 5; respectively 66% and 52%, p = 0.036). Moreover, patients in NLE reached faster a pain score < 5 than patients in CAU (31 versus 54 days respectively, p = 0.026). On all time points, no significant differences in QoL were found between both groups. Conclusions: Controlled pain, i.e. a pain intensity < 5, was reached faster and by more patients with painful bone metastases undergoing RT by the addition of nurse-led pain education. Clinical trial information: NCT01358539.

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Radiofrequency ablation for palliative treatment of osseous metastases results in rapid, significant, and durable improvements in pain relief and quality of life: Results from the OPuS One trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12086 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12086-12086

Author(s):

Jason Levy ◽

Elizabeth David ◽

Thomas Hopkins ◽

Jonathan Morris ◽

Nam D. Tran ◽

...

Keyword(s):

Quality Of Life ◽

Radiofrequency Ablation ◽

Pain Relief ◽

Bone Metastases ◽

Pain Score ◽

Palliative Treatment ◽

Vertebral Augmentation ◽

Painful Bone Metastases ◽

Treated Site

12086 Background: Patients with bone metastases may experience pain and decreased quality of life. Standard of care therapies such as radiation therapy could take weeks for pain relief and carry a risk of radiation induced fracture. Minimally invasive percutaneous radiofrequency ablation (RFA) have been shown in small observational studies to be an alternative treatment for bone metastases. We report the results of the OPuS One trial evaluating RFA for the palliative treatment of patients with painful bone metastases. Methods: OPuS One (NCT03249584) was a multicenter prospective trial. 218 subjects with painful bone metastases (≥ 4/10 worst pain scores, Brief Pain Inventory [BPI], at target treated site) were enrolled from 15 sites. RFA was performed under image guidance at one or two locations. Vertebral augmentation was followed based on physician’s discretion. Subjects’ pain (BPI) and quality of life (EQ-5D) scores were calculated in subjects at three days, one week, and one, three, six, and 12 months post RFA. Rate of complete (0 pain score at treated site with no concomitant analgesic increase) and partial responders (≥ 2 pain score reduction without analgesic increase or analgesic reduction of ≥ 25% from baseline) were calculated. Device-, procedure-, and/or therapy-related adverse events (AEs) were collected. Results: 206 subjects, 113 (55%) female and 93 (45%) males (mean age was 63.7 years) were treated with RFA. Most common primary cancers were breast (23%), lung (23%), and kidney (10%). 184 (89%) subjects were treated for metastatic lesions involving the thoracolumbar spine and 22 (11%) subjects were treated for iliac crest, periacetabulum, sacrum or mixed vertebral and pelvic location. 99% (262/264) of RFA procedures were technically successful and 97% were followed by vertebral augmentation. Subjects reported significant improvement in worst pain from baseline at 7.8 to 5.5, 4.7, 3.6, 3.2, 2.4, and 2.6 at three days, one week and one, three, six, and 12 months post RFA, respectively (p < 0.0001 for all visits). Significant improvements were also seen in average pain (p < 0.0001 for all visits), pain interference (p < 0.0001 for all visits), and quality of life scores (p < 0.0001 for all visits). Overall response rates were 53%, 58%, 61%, 63%, 70%, and 75% at three days, one week, one month, three months, six months, and twelve months post RFA, respectively. Six AEs were reported with three as serious: intra-abdominal fluid collection, pneumonia and respiratory failure. 82 deaths were reported during the study, none were related to the device, therapy, and/or procedure. No skeletal related events were reported. Conclusions: In a large prospective multicenter trial, OPuS One, RFA provided rapid, significant, and durable improvements in pain relief and quality of life up to 12 months. Clinical trial information: NCT03249584.

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Hypervascular Nodules and Stiffer Liver are Associated with Recurrence after Microwave Ablation in Patients with Hepatocellular Carcinoma: A Double-Center Analysis

South Asian Journal of Cancer ◽

10.1055/s-0041-1723102 ◽

2021 ◽

Author(s):

Mona A. H. Shehata ◽

Nabeel El-Kady ◽

Maha Hasaballah ◽

Loai Mansour ◽

Nabila El-Gazzar ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Microwave Ablation ◽

Diabetic Patients ◽

Focal Lesions ◽

Recurrence Rates ◽

Before And After ◽

Risk Factors For Recurrence ◽

Triphasic Ct

Abstract Background and Aims The aim of this study was to detect the most important risk factors for recurrence after microwave ablation (MWA) of hepatocellular carcinoma (HCC). Methods A total of 92 patients with 110 HCC focal lesions (FLs) underwent MWA therapy. All the patients underwent triphasic CT before and after 1 and 3 months of MWA therapy. Complete ablation and recurrence rates were recorded, and the risk factors associated with recurrence were analyzed. Results Regarding the 110 HCC FLs that were detected pre-MWA, adequate ablation was recorded post-MWA procedure in 88 FLs (80%) and incomplete ablation in 22 FLs (showed residual contrast enhancement). However, there were newly detected lesions (17 FLs). The rate of recurrence was significantly higher in patients with multiple larger (> 4 cm) sized and hypervascular nodules. Diabetics were significantly associated with a higher recurrence rate of HCC. The rate of recurrence was significantly higher in patients with baseline level of serum alfa-fetoprotein (AFP) ≥200 ng/mL. Stiffer liver> 25 kPa had higher incidence for recurrence after ablation. Conclusion Meticulous follow-up is mandatory in diabetic patients, patients with AFP > 200 ng/dL starting value, hypervascular large hepatic FL, and in stiffer liver> 25 kPa, as these patients have higher incidence for recurrence after ablation.

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