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

Disparities in Patterns of Conventional Versus Stereotactic Body Radiotherapy in the Treatment of Spine Metastasis in the United States

2020 ◽  
pp. 082585972098220
Author(s):  
Ellen Kim ◽  
Shearwood McClelland ◽  
Jerry J. Jaboin ◽  
Albert Attia
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
Private Insurance ◽  
Spinal Metastases ◽  
The United States ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Cancer Data ◽  
Spine Metastases ◽  
Population Type

Introduction: The improved survival of patients even with metastatic cancer has led to an increase in the incidence of spine metastases, suggesting the need for a more aggressive palliative treatment than conventional external beam radiation therapy (cEBRT). Consequently, spinal stereotactic body radiation therapy (SBRT) has increased in popularity over the past decade. However, there has been no comparison of patterns of usage of cEBRT versus SBRT in the treatment of spinal metastases in the US. Methods: The National Cancer Data Base (NCDB) from 2004-2013 was used for analysis. cEBRT was defined as 30 Gy in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in 1 fraction. SBRT was defined as 25-32 Gy infive5 fractions, 24-32 Gy in 4 fractions, 20-32 Gy in three fractions, 14-32 Gy in 2 fractions, or 14-24 Gy in 1 fraction. Single and multivariable associations between patient demographic and cancer characteristics and type of radiation were performed. Results: From 2004-2013, 23,181 patients with spinal metastases in the United States received cEBRT, while 1,030 received SBRT as part of their first course of treatment. Most patients (88%) received 10 fractions of radiation. Multivariable analysis suggested that non-Medicare or private insurance (adjusted OR 0.4-0.7), African-American race (adjusted OR = 0.8, 95%CI = 0.7-1.0), age 65+ (adjusted OR = 0.8), living in a region with lower population (adjusted OR 0.7), earlier year of diagnosis (OR = 0.9), and receiving treatment in a non-academic/research facility (adjusted OR 0.6) were associated with cEBRT. After controlling for other variables, regional education level was no longer significantly associated with cEBRT. Conclusions: Most patients with spine metastases were treated with cEBRT, usually with 10 fractions. Receipt of SBRT was significantly associated with race, insurance, geography, population, type of treatment facility, and year of diagnosis, even after controlling for other factors. These findings raise questions about disparities in access to and delivery of care that deserve further investigation.

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.

Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases

2014 ◽  
Vol 190 (12) ◽  
pp. 1141-1148 ◽  
Author(s):  
Frederick Mantel ◽  
Stefan Glatz ◽  
André Toussaint ◽  
Michael Flentje ◽  
Matthias Guckenberger
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Spinal Metastases ◽  
Safety And Efficacy ◽  
Stereotactic Body Radiation

scholarly journals Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation

2017 ◽  
Vol 26 (6) ◽  
pp. 725-735 ◽  
Author(s):  
Florian Bernard ◽  
Jean-Michel Lemée ◽  
Olivier Lucas ◽  
Philippe Menei
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinal Metastases ◽  
Pedicle Screw Fixation ◽  
Postoperative Radiation Therapy ◽  
Spine Metastases ◽  
Percutaneous Pedicle Screw

OBJECTIVEIn recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift in focus toward improving quality of life and reducing hospital stay for these patients, and many minimally invasive techniques have been introduced with the aim of reducing the morbidity associated with more traditional open approaches. The goal of this study was to assess the efficacy of long-segment percutaneous pedicle screw stabilization for the treatment of instability associated with thoracolumbar spine metastases in neurologically intact patients.METHODSThis study was a retrospective review of data from a prospective database. The authors analyzed cases in which long-segment percutaneous pedicle screw fixation was performed for the palliative treatment of thoracolumbar spinal instability due to spinal metastases in neurologically intact patients. All of the patients included in the study underwent surgery between January 2014 and May 2015 at the authors' institution. Postoperative radiation therapy was planned within 10 days following the stabilization in all cases. Clinical and radiological follow-up assessments were planned for 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. Outcome was assessed by means of standard postoperative evaluation and oncological and spinal quality of life measures (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 [EORTC QLQ-C30] and Oswestry Disability Index [ODI], respectively). Moreover, 5 patients were given an activity monitoring device for recording the distance walked daily; preoperative and postoperative daily distances were compared.RESULTSData from 17 cases were analyzed. There were no complications, and patients showed improvement in pain level and quality of life from the early postoperative period on. The mean ODI score was 62.7 (range 40–84) preoperatively, 35.4 (range 24–59) on postoperative Day 3, and 46.1 (range 30–76) at 3 weeks, 37.6 (range 25–59) at 6 weeks, 34.0 (range 24–59) at 3 months, 39.1 (range 22–64) at 6 months, and 30.0 (range 20–55) at 1 year after screw placement. The mean ODI was significantly improved in the first 45 days (p < 0.001). Improvement was also evident in scores for functional and symptomatic scales of the EORTC QLQ-C30. All patients underwent postoperative radiation therapy within 10 days (mean 7.5). All patients (n = 5) with an activity monitoring device showed improvement in daily walking distance.CONCLUSIONSLess-invasive palliative treatment for advanced spinal metastases is promising as part of a multidisciplinary approach to the care of patients with metastatic disease. The results of this study indicate that percutaneous surgery may allow for rapid improvement in quality of life and walking ability for patients with thoracolumbar instability due to spine metastases. Long-segment percutaneous screw fixation followed by early radiation therapy appears to be a safe and effective treatment option for providing solid and durable stability and improved quality of life for these patients.

Second Cancer Risk Following Radiation Therapy for Seminoma: A Single Institution Retrospective Study

2012 ◽  
Vol 84 (3) ◽  
pp. S420-S421
Author(s):  
M.R. Folkert ◽  
M.J. Zelefsky ◽  
A. Fidaleo ◽  
D.R. Feldman ◽  
G.J. Bosl ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Cancer Risk ◽  
Second Cancer ◽  
Single Institution ◽  
Second Cancer Risk
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