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Papalexis N, Savarese LG, Peta G, Errani C, Tuzzato G, Spinnato P, Ponti F, Miceli M, Facchini G. The New Ice Age of Musculoskeletal Intervention: Role of Percutaneous Cryoablation in Bone and Soft Tissue Tumors. Curr Oncol 2023; 30:6744-6770. [PMID: 37504355 PMCID: PMC10377811 DOI: 10.3390/curroncol30070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
In the rapidly evolving field of interventional oncology, minimally invasive methods, including CT-guided cryoablation, play an increasingly important role in tumor treatment, notably in bone and soft tissue cancers. Cryoablation works using compressed gas-filled probes to freeze tumor cells to temperatures below -20 °C, exploiting the Joule-Thompson effect. This cooling causes cell destruction by forming intracellular ice crystals and disrupting blood flow through endothelial cell damage, leading to local ischemia and devascularization. Coupling this with CT technology enables precise tumor targeting, preserving healthy surrounding tissues and decreasing postoperative complications. This review reports the most important literature on CT-guided cryoablation's application in musculoskeletal oncology, including sarcoma, bone metastases, and bone and soft tissue benign primary tumors, reporting on the success rate, recurrence rate, complications, and technical aspects to maximize success for cryoablation in the musculoskeletal system.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Leonor Garbin Savarese
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-09, Brazil
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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CIRSE Standards of Practice on Thermal Ablation of Bone Tumours. Cardiovasc Intervent Radiol 2022; 45:591-605. [PMID: 35348870 PMCID: PMC9018647 DOI: 10.1007/s00270-022-03126-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/28/2022] [Indexed: 02/03/2023]
Abstract
Background Percutaneous thermal ablation is an effective, minimally invasive means of treating a variety of focal benign and malignant osseous lesions. To determine the role of ablation in individual cases, multidisciplinary team (MDT) discussion is required to assess the suitability and feasibility of a thermal ablative approach, to select the most appropriate technique and to set the goals of treatment i.e. curative or palliative. Purpose This document will presume the indication for treatment is clear and approved by the MDT and will define the standards required for the performance of each modality. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of thermal ablation of bone tumours. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in thermal ablation of bone tumours. The writing group reviewed the existing literature on thermal ablation of bone tumours, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects from 2009 to 2019. Selected studies published in 2020 and 2021 during the course of writing these standards were subsequently included. The final recommendations were formulated through consensus. Results Recommendations were produced for the performance of thermal ablation of bone tumours taking into account the biologic behaviour of the tumour and the therapeutic intent of the procedure. Recommendations are provided based on lesion characteristics and thermal modality, for the use of tissue monitoring and protection, and for the appropriately timed application of adjunctive procedures such as osseus consolidation and transarterial embolisation. Results Percutaneous thermal ablation has an established role in the successful management of bone lesions, with both curative and palliative intent. This Standards of Practice document provides up-to-date recommendations for the safe performance of thermal ablation of bone tumours.
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Yevich S, Chen S, Metwalli Z, Kuban J, Lee S, Habibollahi P, McCarthy CJ, Irwin D, Huang S, Sheth RA. Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach. Semin Musculoskelet Radiol 2021; 25:795-804. [PMID: 34937119 DOI: 10.1055/s-0041-1740351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Percutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Chen
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeyad Metwalli
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lee
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Habibollahi
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin J McCarthy
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Irwin
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Huang
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sagoo NS, Haider AS, Ozair A, Vannabouathong C, Rahman M, Haider M, Sharma N, Raj KM, Raj SD, Paul JC, Steinmetz MP, Adogwa O, Aoun SG, Passias PG, Vira S. Percutaneous image-guided cryoablation of spinal metastases: A systematic review. J Clin Neurosci 2021; 96:120-126. [PMID: 34840092 DOI: 10.1016/j.jocn.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023]
Abstract
Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0-10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24-40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.
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Affiliation(s)
- Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Ali S Haider
- Texas A&M University College of Medicine, Bryan, TX, United States
| | - Ahmad Ozair
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Christopher Vannabouathong
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Masum Rahman
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Maryam Haider
- John Peter Smith Hospital, Fort Worth, TX, United States
| | - Neha Sharma
- Roseman University of Health Sciences, South Jordan, UT, United States
| | - Karuna M Raj
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sean D Raj
- Department of Radiology, Baylor University Medical Center, Dallas, TX, United States
| | - Justin C Paul
- OrthoConnecticut Orthopedics, Danbury, CT, United States
| | - Michael P Steinmetz
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Owoicho Adogwa
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Gravel G, Roussel A, Mellot F. Anterior epidural carbon dioxide dissection during spine cryoablation. Jpn J Radiol 2021; 40:103-105. [PMID: 34279798 DOI: 10.1007/s11604-021-01171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Spine cryoablation (SC) of posterior vertebral lesions exposes to neuronal damages and incomplete treatment due to the proximity of the spinal canal. Carbon dioxide (CO2) dissection is a nerve protective method that can be used during spine cryoablation that tends to distribute in non-dependent areas. The purpose of this technical note was to expose the feasibility of anterior epidural CO2 dissection during SC in prone decubitus. MATERIALS AND METHODS Three consecutives patients underwent SC of metastases abutting the posterior wall of the vertebra with anterior epidural CO2 dissection. A post-ablation MRI was performed after each cryoablation to state if the treatment was complete or incomplete. Complications were reported using the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). RESULTS Peri-procedural anterior epidural injection of CO2 was successful in all 3 procedures. Treatment was considered complete on all post-ablation MRI with ablation margins encompassing the targeted metastasis. No complication according to the CTCAE was reported. CONCLUSION CO2 dissection of the anterior epidural space was successful in all 3 procedures allowing complete treatment on all post-ablation MRI.
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Affiliation(s)
- Guillaume Gravel
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
| | - Alexandre Roussel
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
| | - François Mellot
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
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Huang JF, Shen J, Li X, Rengan R, Silvestris N, Wang M, Derosa L, Zheng X, Belli A, Zhang XL, Li YM, Wu A. Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:482. [PMID: 32395526 PMCID: PMC7210217 DOI: 10.21037/atm.2020.03.55] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Bones are one of the most common metastatic sites for solid malignancies. Bone metastases can significantly increase mortality and decrease the quality of life of cancer patients. In the United States, around 350,000 people die each year from bone metastases. This study aimed to analyze and update the incidence and prognosis of bone metastases with solid tumors at the time of cancer diagnosis and its incidence rate for each solid cancer. Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to find patients diagnosed with solid cancers originating from outside the bones and joints between 2010 and 2016. Data were stratified by age, sex, and race. Patients with a tumor in situ or with an unknown bone metastases stage were excluded. We then selected most of the sites where cancer often occurred, leaving 2,207,796 patients for the final incidence analysis. For the survival analysis, patients were excluded if they were diagnosed at their autopsy or on their death certificate, or had unknown follow-ups. The incidence of bone metastases and overall survival was compared between patients with different primary tumor sites. Results We identified 2,470,634 patients, including 426,594 patients with metastatic disease and 113,317 patients with bone metastases, for incidence analysis. The incidence of bone metastases among the metastatic subset was 88.74% in prostate cancer, 53.71% in breast cancer, and 38.65% in renal cancer. In descending order of incidence, there were patients with other cancers in the genitourinary system (except for renal, bladder, prostate, and testicular cancer) (37.91%), adenocarcinoma of the lung (ADC) (36.86%), other gynecologic cancers (36.02%), small-cell lung cancer (SCLC) (34.56%), non-small cell lung cancer not otherwise specified and others [NSCLC (NOS/others)] (33.55%), and bladder (31.08%) cancers. The rate of bone metastases is 23.19% in SCLC, 22.50% in NSCLC (NOS/others), 20.28% in ADC, 8.44% in squamous cell carcinoma of the lung (SCC), and 4.11% in bronchioloalveolar carcinoma [NSCLC (BAC)]. As for the digestive system, the overall bone metastases rate was 7.99% in the esophagus, 4.47% in the gastric cancer, 4.42% in the hepatobiliary cancer, 3.80% in the pancreas, 3.26% in other digestive organs, 1.24% in the colorectum, and 1.00% in the anus. Overall, the incidence rate of bone metastases among the entire cohort in breast and prostate cancer was 3.73% and 5.69%, respectively. Conclusions The results of this study provide population-based estimates for the incidence rates of patients with bone metastases at initial diagnosis of their solid tumor. The findings can help clinicians to early detect bone metastases by bone screening to anticipate the occurrence of symptoms and favorably improve the prognosis.
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Affiliation(s)
- Jin-Feng Huang
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital, and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Xiao Li
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Washington, USA
| | - Nicola Silvestris
- IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, Bari, Italy.,Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Minqi Wang
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lisa Derosa
- U1015, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, France
| | - Xuanqi Zheng
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital, and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Andrea Belli
- Department of Abdominal Oncology, National Cancer Institute-Fondazione "G Pascale", IRCCS, Naples, Italy
| | - Xiao-Lei Zhang
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital, and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yan Michael Li
- Department of Neurosurgery and Oncology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - Aimin Wu
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital, and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
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Thermal-ablation of vertebral metastases prevents adverse events in patients with differentiated thyroid carcinoma. Eur J Radiol 2019; 119:108650. [PMID: 31525680 DOI: 10.1016/j.ejrad.2019.108650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/22/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate a strategy that used thermal-ablation of vertebral metastases (VM) to prevent vertebral related events (VRE) in patients with differentiated thyroid cancer (DTC). METHODS This single center study retrospectively reviewed records and post-operative imaging of all DTC patients treated with thermal-ablation for asymptomatic VMs. Rate of local tumor control at first post-operative imaging, 12 and 24 months after thermal-ablation and rate of VREs at 12 and 24 months among the treated VMs were reported. New VMs that occurred during the follow-up and were not considered for additional thermal-ablation were moniroted and VREs were reported. RESULTS Thermal-ablation was used to achieve local control of 41 VMs in 28 patients. Median post-treatment follow-up was 22 months [range: 12-80] and the mean delay for first post-operative imaging was 2 months [range: 0.6-7.5]. Local control at first post-operative imaging, 12 and 24 months was achieved in 87.8%, 82.9% and 75.6%, respectively. Among the treated VMs the rates of VRE was 7.3% at 2 years, significantly lower if local control was achieved at first post-operative imaging than if it was not (0% vs 30%, p = 0.011, OR = 0.184 [95%CI = 0.094-0.360]). After thermal-ablation procedures, 19 news VMs occurred in 11 patients (39.2%) with a median interval of 8 months [range 1-26] and remained untreated. Among these untreated VMs, the rate of VREs at 2 years was significantly higher compared to the treated VMs: (36.8% vs. 7.3%, p = 0.008, OR = 0.135, [95%CI = 0.030-0.607]). CONCLUSION local tumor control of VMs using thermal-ablation decreases the risk of VREs in DTC patients.
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