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Chen AL, Sagoo NS, Vannabouathong C, Reddy Y, Deme S, Patibandla S, Passias PG, Vira S. Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100317. [PMID: 38510810 PMCID: PMC10950794 DOI: 10.1016/j.xnsj.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Background The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach. Methods A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the meta package. Results In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation. Conclusions The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.
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Affiliation(s)
- Andrew L. Chen
- Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX, United States
| | - Navraj S. Sagoo
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Christopher Vannabouathong
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Yashas Reddy
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, United States
| | - Sathvik Deme
- Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX, United States
| | - Sahiti Patibandla
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Peter G. Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, United States
| | - Shaleen Vira
- Department of Orthopedic Surgery, University of Arizona College of Medicine – Phoenix, 475 N 5th St, Phoenix, AZ 85004, United States
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Yao Y, Zhu X, Zhang N, Wang P, Liu Z, Chen Y, Xu C, Ouyang T, Meng W. Microwave ablation versus radiofrequency ablation for treating spinal metastases. Medicine (Baltimore) 2023; 102:e34092. [PMID: 37352076 PMCID: PMC10289525 DOI: 10.1097/md.0000000000034092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical efficacy and safety of microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of spinal metastases. METHODS A literature search was performed using the PubMed, Web of Science, and Cochrane Library databases according to the PRISMA statement (as of September 20, 2022). Two independent investigators screened articles based on the inclusion and exclusion criteria and included studies with primary outcomes of pain relief, tumor control, and complications. Article quality was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. RESULTS Sixteen articles were finally included in this study, including 630 patients with spinal metastases, with ages ranging from 51.4 to 71.3 years. Of these, 393 (62.4%) underwent MWA and 237 (37.6%) underwent RFA. After MWA and RFA treatment, visual analog scale scores significantly decreased, and the local tumor control rates were all above 80%. Complications were reported in 27.4% of patients treated with MWA compared with 10.9% of patients treated with RFA. CONCLUSION The results of this systematic review suggest that MWA alone or in combination with surgery and RFA in combination with other modalities may improve pain caused by primary tumor metastasis to the spine, and MWA alone or in combination with surgery may have better local tumor control. However, MWA appears to result in more major complications than RFA in combination with other treatment modalities.
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Affiliation(s)
- Yuming Yao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Xiang Zhu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Na Zhang
- Department of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Wang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhizheng Liu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Chen
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cong Xu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Taohui Ouyang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Meng
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Pusceddu C, Marsico S, Derudas D, Ballicu N, Melis L, Zedda S, De Felice C, Calabrese A, Santucci D, Faiella E. Clinical Rationale of Using Steerable Technologies for Radiofrequency Ablation Followed by Cavity Creation and Cement Augmentation in the Treatment of Painful Spinal Metastases. Curr Oncol 2023; 30:4257-4268. [PMID: 37185437 PMCID: PMC10136743 DOI: 10.3390/curroncol30040324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Cement distribution after radiofrequency ablation of spinal metastases can be unpredictable due to various tumor factors, and vertebral augmentation requires advanced devices to prevent cement leakage and achieve satisfactory filling. The purpose of this study is to evaluate the safety and efficacy of a platform of steerable technologies with an articulating radiofrequency ablation (RFA) probe and targeted cavity creation before vertebral augmentation in the treatment of painful spinal metastases. (2) Methods: Sixteen patients (mean age, 67 years) underwent RFA in conjunction with vertebral augmentation after the creation of a targeted balloon cavity for metastatic spinal disease and were followed up to 6 months. Pain and functional mobility were assessed before treatment and postoperatively using the Visual Analogue Score (VAS) and Functional Mobility Scale (FMS). Complications, predictability of cement distribution, anatomical restoration, and local recurrence were collected. Technical success was defined as successful intraoperative ablation and predictable cement distribution after cavity creation without major complications. (3) Results: Sixteen patients with 21 lesions were treated for tumors involving the thoracolumbar spine. All treatments were technically successful and were followed by targeted cavity creation and vertebral augmentation. A statistically significant reduction in median VAS score was observed before treatment and 1 week after RFA treatment (p < 0.001). A total of six of the seven patients who reported limited painful ambulation before treatment reported normal ambulation 1 month after treatment, while the remaining patient reported no improvement. Patients who reported wheelchair use before treatment improved to normal ambulation (four/eight) or limited painful ambulation (four/eight). The improvement in mobility before and after treatment was statistically significant (p = 0.002). Technical success was achieved in all the combined procedures. (4) Conclusions: The combined treatment of RFA and vertebral augmentation with a steerable platform that allows the creation of a targeted cavity prior to cement injection proved to be a safe and effective procedure in our patient sample, resulting in improved quality of life as assessed by the Visual Analogue Score (VAS) and Functional Mobility Scale (FMS).
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | | | - Daniele Derudas
- Department of Hematology, Businco Hospital, 09121 Cagliari, Italy
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | - Luca Melis
- Nuclear Medicine Department, Businco Hospital, 09121 Cagliari, Italy
| | - Stefano Zedda
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | - Carlo De Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Wang L, Lu M, Zhang X, Zhao Z, Li X, Liu T, Xu L, Yu S. Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases. Front Oncol 2023; 13:1129658. [PMID: 37213292 PMCID: PMC10196379 DOI: 10.3389/fonc.2023.1129658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
Objective Pulmonary cement embolism is a rare but underestimated complication of vertebroplasty due to the relative lack of study and examination. This study aims to investigate the incidence of pulmonary cement embolism in patients with spinal metastasis who undergo PVP with RFA and to analyze the relative risk factors. Methods A total of 47 patients were retrospectively included and classified into pulmonary cement embolism (PCE) group and non-pulmonary cement embolism (NPCE) group by comparing pre- and postoperative pulmonary CT scan images. The demographic and clinical information of the patients was obtained. Demographic data in the two groups were compared using the chi-square test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was used to identify risk factors related to pulmonary cement embolism. Results Pulmonary cement embolism was detected in 11 patients (23.4%), and all patients were asymptomatic and followed up regularly. Risk analysis showed that multiple segments (≥3, p=0.022), thoracic vertebrae (p=0.0008), and unipedicular puncture approach (p=0.0059) were risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra (p<0.0001). Vein leakage of cement was related to the integrity of the vertebral cortex. Conclusion The number of involved vertebrae, lesion location, and puncture approach are independent risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra. Surgeons should consider these factors when formulating therapeutic strategies.
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Affiliation(s)
- Luqiang Wang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Lu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenguo Zhao
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Libin Xu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Shengji Yu,
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Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:jcm11123265. [PMID: 35743336 PMCID: PMC9225477 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
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