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Faiella E, Vaccarino F, Pacella G, Santucci D, Vergantino E, Bruno A, Ragone R, Zobel BB, Grasso RF. Exploring the Efficacy of Combining Radiofrequency Thermal Ablation or Microwave Ablation with Vertebroplasty for Pain Control and Disease Management in Metastatic Bone Disease-A Systematic Review. Curr Oncol 2024; 31:5422-5438. [PMID: 39330029 PMCID: PMC11430811 DOI: 10.3390/curroncol31090401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/31/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Interventional radiology techniques have become pivotal in recent years in managing metastatic bone disease, which frequently results in skeletal complications such as fractures and severe pain. Thermoablative methods like radiofrequency ablation (RFA) and microwave ablation (MWA), when combined with vertebroplasty (VP), are proving increasingly beneficial for these patients. METHODS The search was independently conducted by two radiologists on MEDLINE databases, using specified strings up to April 2024. Methodological quality was assessed using PRISMA guidelines. Studies meeting inclusion criteria investigated thermoablation techniques (RFA and/or MWA) combined with VP, focusing on pain management and disease control outcomes in adults. RESULTS Among 147 results, 42 articles met the criteria, with varied prospective and retrospective designs and sample sizes averaging 49 patients, predominantly involving RFA (30 studies), MWA (11 studies), and one comparative study. Our review highlights significant pain reduction, effective local tumor control, and favorable safety of combined RFA or MWA with VP, supporting its potential in managing vertebral pathologies and warranting further clinical integration. CONCLUSIONS The combined treatment of RFA/MWA with VP demonstrates significant pain reduction and local tumor control, with a rapid onset of analgesic effect. These findings support its crucial role in clinical practice for managing vertebral metastases.
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Affiliation(s)
- Eliodoro Faiella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Federica Vaccarino
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giuseppina Pacella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Domiziana Santucci
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Elva Vergantino
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Amalia Bruno
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Raffaele Ragone
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Spyropoulou D, Tsiganos P, Dimitrakopoulos FI, Tolia M, Koutras A, Velissaris D, Lagadinou M, Papathanasiou N, Gkantaifi A, Kalofonos H, Kardamakis D. Radiotherapy and Renal Cell Carcinoma: A Continuing Saga. In Vivo 2021; 35:1365-1377. [PMID: 33910814 PMCID: PMC8193295 DOI: 10.21873/invivo.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/10/2022]
Abstract
Renal cell carcinoma (RCC) is one of the most aggressive malignancies of the genito-urinary tract, having a poor prognosis especially in patients with metastasis. Surgical resection remains the gold standard for localized renal cancer disease, with radiotherapy (RT) receiving much skepticism during the last decades. However, many studies have evaluated the role of RT, and although renal cancer is traditionally considered radio-resistant, technological advances in the RT field with regards to modern linear accelerators, as well as advanced RT techniques have resulted in breakthrough therapeutic outcomes. Additionally, the combination of RT with immune checkpoint inhibitors and targeted agents may maximize the clinical benefit. This review article focuses on the role of RT in the therapeutic management of renal cell carcinoma.
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Affiliation(s)
- Despoina Spyropoulou
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece;
| | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Foteinos-Ioannis Dimitrakopoulos
- Division of Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece
- Clinical and Molecular Oncology Laboratory, Medical School, University of Patras, Patras, Greece
| | - Maria Tolia
- Radiotherapy Department, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Angelos Koutras
- Division of Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitris Velissaris
- Emergency Department and Internal Medicine Department, University Hospital of Patras, Patras, Greece
| | - Maria Lagadinou
- Emergency Department University Hospital of Patras, Patras, Greece
| | | | - Areti Gkantaifi
- Radiotherapy Department, Interbalkan Medical Center, Thessaloniki, Greece
| | - Haralabos Kalofonos
- Division of Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
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Ablation, consolidation and radiotherapy for the management of metastatic lesions of the spine: impact on the quality of life in a mid-term clinical and diagnostic follow-up in a pilot study. Med Oncol 2020; 37:53. [DOI: 10.1007/s12032-020-01378-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
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Westhoff PG, de Graeff A, Monninkhof EM, de Pree I, van Vulpen M, Leer JWH, Marijnen CAM, van der Linden YM. Effectiveness and toxicity of conventional radiotherapy treatment for painful spinal metastases: a detailed course of side effects after opposing fields versus a single posterior field technique. ACTA ACUST UNITED AC 2017; 7:17-26. [PMID: 29576859 PMCID: PMC5856865 DOI: 10.1007/s13566-017-0328-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 12/25/2022]
Abstract
Background Conventional radiotherapy for painful spinal metastases can be delivered with a single posterior-anterior (PA) or two opposed anterior-posterior (APPA) fields. We studied the effectiveness and toxicity of both techniques and studied whether treatment technique was predictive for abdominal and skin toxicity. Patients and methods Within the Dutch Bone Metastasis Study, 343 patients received 8 Gray in a single fraction or 24 Gray in six fractions for painful spinal metastases. Treatment technique was not randomized. At baseline and weekly during follow-up, patients reported pain and other physical complaints. Any complaint increasing within 4 weeks after treatment was noted as a side effect. Pain response was calculated according to international standards, taking into account changes in pain score and medication. Repeated measurement analyses and multivariate logistic analyses were performed. Results Patients were mainly treated on the thoracic (34%) and lumbar (53%) spine and 73% received a PA field. Pain response was similar between both techniques (74%). In patients treated at the thoraco-lumbar and lumbar spine, with multiple fractions, significantly more abdominal complaints were noticed. In multivariate analysis, radiotherapy technique did not predict for side effects. Conclusion Conventional radiotherapy of painful spinal metastases provides limited toxicity. Radiotherapy technique is not an independent predictor of abdominal and skin toxicity of irradiation.
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Affiliation(s)
- Paulien G Westhoff
- 1Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.,2Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Alexander de Graeff
- 3Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- 4Julius center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Ilse de Pree
- 5Department of Radiation Oncology, Erasmus Medical Center, PO Box 5201, 3008 AE Rotterdam, the Netherlands
| | - Marco van Vulpen
- 1Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Jan Willem H Leer
- 2Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Corrie A M Marijnen
- 6Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Yvette M van der Linden
- 6Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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Ma Y, Wallace AN, Madaelil TP, Jennings JW. Treatment of osseous metastases using the Spinal Tumor Ablation with Radiofrequency (STAR) system. Expert Rev Med Devices 2016; 13:1137-1145. [PMID: 27807994 DOI: 10.1080/17434440.2016.1256772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Percutaneous ablation is an emerging, minimally invasive therapy for patients with osseous metastases who have not responded or have contraindications to radiation therapy. Goals of therapy are pain relief, and in some cases, prevention of local tumor progression. Areas covered: The epidemiology, pathophysiology, natural history, and traditional management of metastatic bone disease are reviewed. Novel features of the Spinal Tumor Ablation with Radiofrequency (STAR) System (DFINE, San Jose, CA) that facilitate treatment of osseous metastases are described, including the bipolar electrode, extensible distal tip that can be curved up to 90°, and inclusion of thermocouples that enable real-time monitoring of the ablation zone volume. Lastly, research evaluating the safety and efficacy of using this device to treat musculoskeletal metastases is summarized. Expert commentary: Although evidence supporting the efficacy of RFA for the treatment of bone metastases is limited to case series, it is a reasonable therapy when other options have been exhausted, especially given the safety and minimal morbidity of the procedure. The STAR Tumor Ablation System has expanded the anatomic scope of bone metastases that can be safely and effectively treated with percutaneous ablation.
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Affiliation(s)
- Yuntong Ma
- a Washington University School of Medicine , St. Louis , MO , USA
| | - Adam N Wallace
- b Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , MO , USA
| | - Thomas P Madaelil
- b Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , MO , USA
| | - Jack W Jennings
- b Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , MO , USA
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Critical role of HIFU in musculoskeletal interventions. Radiol Med 2014; 119:470-5. [PMID: 24894922 DOI: 10.1007/s11547-014-0414-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a totally noninvasive ablation technique that in the last years had an important development in a large number of applications: in particular gynaecological disorders, bone lesions, prostate, breast, brain and other organs. This review of MRgFUS is focused on the technical aspects and the current clinical application in musculoskeletal interventions. More precisely, this paper aims to review the relatively scarce literature on this topic also in comparison with our 3-year experience in the use of this technique in the field of musculoskeletal interventions.
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Waldeland E, Brustugun OT, Ramberg C, Helland Å. [Stereotactic irradiation in spinal metastases]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:2478-9. [PMID: 23338027 DOI: 10.4045/tidsskr.12.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Einar Waldeland
- Avdeling for medisinsk fysikk, Oslo universitetssykehus, Radiumhospitalet, Norway.
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Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, Conchiglia A, Ventura L, Franzese P, Gallucci M, Masciocchi C, Tombolini V. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol 2011; 21:2004-10. [DOI: 10.1007/s00330-011-2133-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/12/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, Conchiglia A, Franzese P, Gallucci M, Masciocchi C, Tombolini V. Can radiotherapy be combined with radiofrequency ablation in the management of symptomatic osteolytic skeletal metastasis? Clin Oncol (R Coll Radiol) 2010; 23:65-6. [PMID: 21106354 DOI: 10.1016/j.clon.2010.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 10/19/2010] [Accepted: 11/01/2010] [Indexed: 11/24/2022]
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