PP126 Radiofrequency Ablation For Metastatic Spinal Lesions

IntroductionAbout 70 percent of metastatic breast, lung, and prostate cancers affect the bones. When this phase of the disease affects the spine, the mobility and quality of life of patients are severely impaired. Radiofrequency ablation (RFA) has become a feasible option in the palliative treatment of vertebral metastases due to its minimal invasiveness and short procedure time. This health technology assessment report aimed to identify, evaluate, and synthesize evidence on the safety, effectiveness, and cost effectiveness of RFA for vertebral metastases.MethodsA systematic search was conducted to identify literature published from December 2016 to July 2019 in the following databases: Medline, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination. Systematic reviews, randomized and non-randomized controlled trials, and case series studies evaluating the efficacy and safety of RFA in patients with vertebral metastases were included.ResultsSixteen studies were included: two systematic reviews, 13 case series studies, and one comparative study. None of the systematic reviews identified any randomized controlled trials. Of the 14 included primary studies, 10 evaluated RFA in combination with vertebroplasty, three evaluated RFA in combination with kyphoplasty, and one study evaluated a combination of RFA and radiation therapy. In all cases, the evaluated patients had different types of cancer (e.g., breast, lung, or liver). The follow-up periods varied between the studies from one day to 12 months. The most commonly used RFA devices were the STAR™ Tumour Ablation System (Merit Medical Systems) and the OsteoCool™ Radiofrequency Ablation System (Medtronic).ConclusionsRFA reduces pain, improves functional capacity, and provides greater local control of disease, potentially giving patients a higher quality of life, even in the context of metastatic disease. Although there is evidence on the safety and efficacy of this technology for the palliative treatment of vertebral metastases, more studies with higher methodological quality are needed. There were no studies available on the cost effectiveness of RFA for this indication.

Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome

Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology.

Diffuse vertebral metastases from glioblastoma with vertebroepidural diffusion: A case report and review of the literature

Background: The occurrence of extraneural metastasis in patients diagnosed with glioblastoma (GBM) is rare with an estimated incidence ranging from 0.4% to 2.0%. Short clinical history is believed to be a possible explanation of the paucity of such cases. Furthermore, to date, only few papers describe cases of vertebral metastases from GBM without evidence of synchronous visceral involvement. Case Description: The authors report on the case of a 46-year-old woman presenting with a history of surgically treated GBM who developed multiple metastases located in the posterior laminae and vertebral bodies with a single dural metastasis at D6-D8 level 5 years after the initial diagnosis. Total-body computed tomography did not show signs of either intracranial recurrence or visceral involvement. Postoperative pathological examination confirmed the diagnosis of the World Health Organization-2016 Grade IV GBM metastases. Conclusion: From a clinical point of view, the awareness of the possibility of spinal and vertebral metastasis from intracranial GBM is crucial. The present case demonstrates that distant dissemination from the primary tumor is possible despite the absence of intracranial recurrence.

Case report of a rare giant bone island in a vertebral body combined with hemangioma

This case report describes a rare giant bone island combined with hemangioma diagnosed in a patient with osteolytic vertebral metastases. The bone island’s greatest diameter was 3.15 cm, and bone islands of this size are rare in the literature. This article aims to provide clinicians with information about the diagnosis and relevant literature of bone islands.

Changes in Spinal Instability After Combined Therapy of Conventional Radiotherapy and Bone Modifying Agents for Painful Vertebral Bone Metastases

Precise assessment of spinal instability is critical at the beginning and after radiotherapy for selection of the treatment and evaluating the effectiveness of radiotherapy. We investigated changes of spinal instability after radiotherapy and examined potential risk factors for the difference of the outcome of spinal instability for painful spinal metastases. We evaluated 81 patients who received radiotherapy for painful vertebral metastases in our institution between 2012 and 2016. The pain at the vertebrae was assessed. Radiological responses of irradiated vertebrae were assessed by computed tomography. Spinal instability was assessed by Spinal Instability Neoplastic Score (SINS). Follow-up assessments were done at the start of radiotherapy and at 1, 2, 3, 4, and 6 months after radiotherapy. At each of one to six months, pain disappeared in 62%, 84%, 93%, 98%, and 100% of patients. The median SINS were 8, 7, 6, 5, 5, and 4 at the beginning of radiotherapy and after 1, 2, 3, 4, and 6 months, respectively, which significantly decreased over time (P < 0.001). Multivariate analysis revealed that PLISE was the only risk factor for spinal instability at one month. In conclusion, spinal instability significantly improved over time after radiotherapy. Clinicians should take attention to PLISE in the radiotherapy of vertebral metastases.