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Yao PF, Hu A, Mansour F, Nadeem I, Jiang Y, Athreya S. Image-Guided Energy Ablation for Palliation of Painful Bony Metastases-A Systematic Review. J Vasc Interv Radiol 2024; 35:1268-1277. [PMID: 38815751 DOI: 10.1016/j.jvir.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE To analyze the effectiveness of image-guided energy ablation techniques with and without concurrent therapies in providing palliative pain relief in patients with bone metastases. MATERIALS AND METHODS Ovid Embase, Ovid Medline, and Pubmed were searched from inception to April 14, 2023, using search terms related to bone lesions and MeSH terms regarding ablation therapy. English peer-reviewed primary articles were included that reported pain scores following image-guided energy-based ablation of bone metastases. Exclusion criteria included nonpalliative treatment, pain scores associated with specific treatment modalities not reported, and nonmetastatic bone lesions. Mean percentage reduction in pain score was calculated. RESULTS Of the 1,396 studies screened, 54 were included. All but 1 study demonstrated decreased pain scores at final follow-up. Mean reductions in pain scores at final follow-up were 49% for radiofrequency (RF) ablation, 58% for RF ablation and adjunct, 54% for cryoablation (CA), 72% for cryoablation and adjunct (CA-A), 48% for microwave ablation (MWA), 81% for microwave ablation and adjunct (MWA-A), and 64% for high-intensity focused ultrasound (US). Postprocedural adverse event rates were 4.9% for RF ablation, 34.8% for RF ablation and adjunct, 9.6% for CA, 12.0% for CA-A, 48.9% for MWA, 33.5% for MWA-A, and 17.0% for high-intensity focused US. CONCLUSIONS Image-guided energy ablation demonstrated consistently strong reduction in pain across all modalities, with variable postprocedural adverse event rates. Owing to heterogeneity of included studies, quantitative analysis was not appropriate. Future primary research should focus on creating consistent prospective studies with established statistical power, explicit documentation, and comparison with other techniques.
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Affiliation(s)
- Patrick F Yao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Angela Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Fadi Mansour
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ibrahim Nadeem
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Yixin Jiang
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sriharsha Athreya
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Niagara Health System, St. Catherines General Site, St. Catherines, Ontario, Canada
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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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Bahouth SM, Yeboa DN, Ghia AJ, Tatsui CE, Alvarez-Breckenridge CA, Beckham TH, Bishop AJ, Li J, McAleer MF, North RY, Rhines LD, Swanson TA, Chenyang W, Amini B. Advances in the management of spinal metastases: what the radiologist needs to know. Br J Radiol 2023; 96:20220267. [PMID: 35946551 PMCID: PMC10997009 DOI: 10.1259/bjr.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Spine is the most frequently involved site of osseous metastases. With improved disease-specific survival in patients with Stage IV cancer, durability of local disease control has become an important goal for treatment of spinal metastases. Herein, we review the multidisciplinary management of spine metastases, including conventional external beam radiation therapy, spine stereotactic radiosurgery, and minimally invasive and open surgical treatment options. We also present a simplified framework for management of spinal metastases used at The University of Texas MD Anderson Cancer Center, focusing on the important decision points where the radiologist can contribute.
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Affiliation(s)
- Sarah M Bahouth
- Musculoskeletal Imaging and Intervention Department, Brigham
and Women’s Hospital, Boston, United States
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Claudio E Tatsui
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | | | - Thomas H Beckham
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Robert Y North
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Laurence D Rhines
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Wang Chenyang
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas
MD Anderson Cancer Center, Houston, TX, United
States
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The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective. Life (Basel) 2022; 12:life12040571. [PMID: 35455062 PMCID: PMC9032747 DOI: 10.3390/life12040571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022] Open
Abstract
Spine represents the most common site for metastatic disease involvement. Due to the close relationship between the spinal cord and critical structures, therapeutical management of metastatic spinal cord disease remains challenging. Spinal localization can lead to neurological sequelae, which can significantly affect the quality of life in patients with a limited life expectancy. The authors conducted a systematic literature review according to PRISMA guidelines in order to determine the impact of the most updated palliative care on spinal metastases. The initial literature search retrieved 2526 articles, manually screened based on detailed exclusion criteria. Finally, 65 studies met the inclusion criteria and were finally included in the systematic review. In the wide scenario of palliative care, nowadays, recent medical or surgical treatments represent valuable options for ameliorating pain and improving patients QoL in such this condition.
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Dalili D, Isaac A, Garnon J, Cazzato RL, Gangi A. Towards Personalized Musculoskeletal Interventional Oncology: Enhanced Image-Guided Biopsies and Interventions. Semin Roentgenol 2022; 57:201-211. [DOI: 10.1053/j.ro.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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Cazzato RL, Jennings JW, Autrusseau PA, De Marini P, Auloge P, Tomasian A, Garnon J, Gangi A. Percutaneous image-guided cryoablation of spinal metastases: over 10-year experience in two academic centers. Eur Radiol 2022; 32:4137-4146. [PMID: 35028752 DOI: 10.1007/s00330-021-08477-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To report on safety and clinical effectiveness of cryoablation for the treatment of spinal metastases (SM) in patients needing pain palliation or local tumor control (LTC). METHODS All consecutive patients with SM who underwent cryoablation from May 2008 to September 2020 in two academic centers were retrospectively identified and included in the present analysis. Patient characteristics, goal of treatment (curative/palliative), SM characteristics, procedural details, and clinical outcomes (pain relief; local tumor control [LTC]) were analyzed. RESULTS There were 74 patients (35 women; median age 61 years) accounting for 105 SM. Additional cementoplasty was used for 76 SM (76/105; 72.4%). There were 9 complications (out of 105 SM [8.5%]; 2 major and 7 minor) in 8 patients. Among the 64 (64/74; 86.5%) patients with painful SM, the mean Numerical Pain Rating Scale dropped from 6.8 ± 2.2 (range, 0-10) at the baseline to 4.1 ± 2.4 (range, 0-9; p < 0.0001) at 24 h, 2.5 ± 2.6 (range, 0-9; p < 0.0001) at 1 month, and 2.4 ± 2.5 (range, 0-9; p < 0.0001) at the last available follow-up (mean 14.7 ± 19.6 months; median 6). Thirty-four patients (34/64; 53.1%) were completely pain-free at the last follow-up. At mean 25.9 ± 21.2 months (median 16.5) of follow-up, LTC was achieved in 23/28 (82.1%) SM in 21 patients undergoing cryoablation with curative intent. CONCLUSION Cryoablation of SM, often performed in combination with vertebral augmentation, is safe, achieves fast and sustained pain relief, and provides high rates of LTC at mean 2-year follow-up. KEY POINTS •Cryoablation of spinal metastases is safe. •Cryoablation of spinal metastases allows rapid and sustained pain relief. •The mean 2-year rate of local tumor control after cryoablation of spinal metastases is 82.1%.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France. .,Medical Oncology, Institut de Cancérologie Strasbourg Europe, 17, Rue Albert Calmette, 67200, Strasbourg, France.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Anderanik Tomasian
- Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA, 90033, USA
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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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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