Computed Tomography‒Guided Microwave Ablation Combined with Osteoplasty for the Treatment of Bone Metastases: A Multicenter Clinical Study

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation

Introduction

The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases.

Methods

Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis.

Results

In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow-up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively.

Conclusion

In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors: WFNS spine committee recommendations

OBJECTIVE

This review aims to formulate the most current, evidence-based recommendations regarding complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors.

METHODS

A systematic literature search in PubMed and MEDLINE, and was performed from 2013 to 2023 using the search terms "complications" + "spine metastases", "spine metastases" + + "rehabilitation", "spine metastases" + "pain therapy" + "palliative care". Screening criteria resulted in 35, 15 and 56 studies respectively that were analyzed. Using the Delphi method and two rounds of voting at two separate international meetings, nine members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements.

RESULTS

Preoperative assessment for complications following surgery in patients with metastatic spine tumors should include estimation of Karnofsky score, site of primary tumor, number of spinal and visceral metastasis, ASA score and preoperative Hb (Hemoglobin) value. Complication risk factors are age > 65 years, preoperative ASA score of 3 and 4 and greater operative blood loss. Pain management using WHO analgesic concept and early mobilization are needed, starting with non-opioids, weak opioids followed by strong opioids. Morphine is the first choice for moderate to severe pain whereas IV-PCA may be used for severe breakthrough pain with monitoring. Use of bisphosphonates is considered in cases of non-localized pain and not accessible radiation therapy.

CONCLUSIONS

These nine final consensus statements provide current, evidence-based guidelines on complication avoidance, rehabilitation, pain therapy and palliative care for patients with spinal metastases.

Image-Guided Energy Ablation for Palliation of Painful Bony Metastases-A Systematic Review

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.

CT-Guided Microwave Ablation with Vertebral Augmentation for Spinal Metastases with Posterior Wall Defects

Purpose

To evaluate the efficacy and safety of combined microwave ablation (MWA) and vertebral augmentation (VA) in the treatment of spinal metastases with posterior wall defects.

Patients and Methods

A retrospective review was conducted for 67 patients (42 men, 25 women) with painful spine metastases and posterior wall defects who underwent MWA combined with VA. Among these patients, 52 vertebrae had no epidural invasion and 33 had mild invasion but did not compress the spinal cord. Procedural effectiveness was determined by comparing visual analog scale (VAS) scores and Oswestry disability index (ODI) scores before the procedure and during the follow-up period.

Results

The procedure was technically successful in all patients. The mean VAS score declined significantly from 6.85 ± 1.81 before the procedure to 3.27 ± 1.97 at 24 h, 1.96 ± 1.56 at 1 week, 1.84 ± 1.50 at 4 weeks, 1.73 ± 1.45 at 12 weeks, and 1.71 ± 1.52 at 24 weeks post-procedure (p < 0.01). The mean ODI score was lower post-procedure than before the procedure (p < 0.001). Transient nerve injury occurred in two patients (SIR classification D), and the incidence of asymptomatic bone cement (SIR classification A) was 43.5% (37/85).

Conclusion

MWA combined with VA is an effective and safe treatment for painful spine metastases with posterior wall defects.

Analgesic efficacy and safety of percutaneous thermal ablation plus cementoplasty for painful bone metastases: a systematic review and meta-analysis

PURPOSE

To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases.

METHODS

We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed.

RESULTS

Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26-7.95, I2 = 89%), 3.30 (95% CI, 2.25-4.82, I2 = 98%), 2.58 (95% CI, 1.99-3.35, I2 = 94%), 2.02 (95% CI, 1.50-2.71, I2 = 93%), 1.78 (95% CI, 1.26-2.53, I2 = 95%), and 1.62 (95% CI, 1.14-2.31, I2 = 88%), and in the subgroup, 7.97 (95% CI, 7.45-8.52, I2 = 86%), 3.01 (95% CI, 1.43-6.33, I2 = 98%), 2.95 (95% CI, 1.93-4.51, I2 = 95%), 2.34 (95% CI, 1.82-3.01, I2 = 68%), 2.18 (95% CI, 1.57-3.03, I2 = 78%), and 2.01 (95% CI, 1.16-3.48, I2 = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2-6%, I2 = 2%).

CONCLUSIONS

The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction.

Safety and clinical efficacy of microwave ablation combined with percutaneous vertebroplasty in the treatment of multisegmental spinal metastases

OBJECTIVE

To evaluate the safety and efficacy of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of multisegmental (2-3 segments) osteolytic spinal metastases.

MATERIALS AND METHODS

This study comprised a retrospective analysis of data from 20 patients with multisegmental (2-3 segments) osteolytic spinal metastases who received MWA combined with PVP. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22), and local recurrence before and after the operation were measured. The occurrence of complications was observed to evaluate safety.

RESULTS

All operations were completed successfully with no serious complications. Transient nerve injury occurred in two cases, but recovered after symptomatic treatment. The bone cement leakage rate was 13.9% (6/43). The mean baseline VAS scores were 7.25 ± 0.91 before treatment and 7.25 ± 0.91, 3.70 ± 1.12, 2.70 ± 0.73, 2.40 ± 0.68, 2.25 ± 0.71, and 2.70 ± 0.92 at 1 day, 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (P < 0.001). The mean baseline ODI score decreased from 56.90 ± 9.74 before treatment to 41.90 ± 7.09, 38.10 ± 7.93, and 38.80 ± 10.59 at 1, 3, and 6 months after treatment, respectively; all values were significantly lower (P < 0.001). The average QLQ-BM22 baseline score decreased from 54.10 ± 5.36 before treatment to 44.65 ± 5.22, 43.05 ± 4.78, 42.30 ± 4.06, and 42.15 ± 5.47 at 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (all P < 0.001). The postoperative survival time of all patients was >6 months. In three patients, four vertebral segments recurred 6 months after operation.

CONCLUSION

MWA combined with PVP is a safe and effective treatment for multisegmental osteolytic vertebral metastases that can effectively relieve pain, improve spinal function, improve quality of life, and delay tumor progression. However, it is a long operation, necessitating good preoperative preparation and effective intraoperative pain relief measures.

Clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty for palliative treatment in pelvic osteolytic metastases

OBJECTIVES

To evaluate the impact of microwave ablation (MWA) on pain relief, quality of life, mobility, and local tumour progression in adult patients with pelvic osteolytic bone metastasis and to test the safety of MWA.

METHODS

This study retrospectively analysed the data from 20 patients with pelvic osteolytic metastases who received MWA combined with percutaneous osteoplasty (POP). The visual analogue scale (VAS), musculoskeletal tumour society system (MSTS), and Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22) were used to evaluate the pain, limb function, and quality of life. The intraoperative and postoperative complications were recorded. The tumour recurrence and survival time were analysed during the follow-up period (range 3-26 months).

RESULTS

All (n = 20) MWA and POP operations were completed successfully. Four patients (20%; 95% CI, 6%-44%) had mild bone cement leakage from surrounding tissues, and there were no obvious symptoms or serious complications. There were significant differences in VAS, MSTS, and QLQ-BM22 scores before and after the operation (P < .001). During the postoperative follow-up period, 9 patients died. The median survival time was 8 months (range 3-26 months; IQR: 4.5-13; 95% CI, 4.2-15.3 months), and the 1-year survival rate was 65% (13/20; 95% CI, 41%-85%). Tumour recurrence occurred in 4 cases (20%; 95% CI, 6%-44%) after the operation, and the median time of recurrence was 12 months (range 8-16 months; IQR: 8.25-12.75; 95% CI, 5.5-18.5 months).

CONCLUSIONS

MWA combined with POP is an effective and safe treatment for pelvic osteolytic metastases. It can significantly relieve local pain, reconstruct limb function, improve patients' quality of life, and effectively control local tumour progression.

ADVANCES IN KNOWLEDGE

So far, the experience of using microwave in the treatment of pelvic metastases is still limited. MWA combined with POP in the treatment of pelvic osteolytic metastases can provide significant clinical benefits in acceptable low-risk minimally invasive situations and should be provided to patients with appropriate pelvic metastases in a multidisciplinary approach.

Musculoskeletal Interventional Oncology: A Contemporary Review

Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.

Microwave ablation versus radiofrequency ablation for treating spinal metastases

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.

Microwave ablation combined with vertebral augmentation under real-time temperature monitoring for the treatment of painful spinal osteogenic metastases

OBJECTIVE

To evaluate the safety and efficacy of computed tomography (CT)-guided microwave ablation combined with vertebral augmentation under real-time temperature monitoring in the treatment of painful osteogenic spinal metastases.

METHODS

This retrospective study included 38 patients with 63 osteogenic metastatic spinal lesions treated using CT-guided microwave ablation and vertebral augmentation under real-time temperature monitoring. Visual analog scale scores, daily morphine consumption, and Oswestry Disability Index scores were used to evaluate efficacy of the treatment.

RESULTS

Microwave ablation combined with vertebral augmentation reduced the mean visual analog scale scores from 6.40 ± 1.90 preoperatively to 3.32 ± 0.96 at 24 h, 2.24 ± 0.91 at 1 week, 1.92 ± 1.32 at 4 weeks, 1.79 ± 1.45 at 12 weeks, and 1.39 ± 1.12 at 24 weeks postoperatively (all p < 0.001). The mean preoperative daily morphine consumption was 108.95 ± 56.41 mg, which decreased to 50.13 ± 25.46 mg at 24 h, 31.18 ± 18.58 mg at 1 week, 22.50 ± 16.63 mg at 4 weeks, 21.71 ± 17.68 mg at 12 weeks, and 17.27 ± 16.82 mg at 24 weeks postoperatively (all p < 0.001). During the follow-up period, the Oswestry Disability Index scores significantly reduced (p < 0.001). Bone cement leakage occurred in 25 vertebral bodies, with an incidence of 39.7% (25/63).

CONCLUSIONS

The results indicate that microwave ablation combined with vertebral augmentation under real-time temperature monitoring is a feasible, effective, and safe treatment for painful osteoblast spinal metastases.

SPACES: Our team's experience in lung tumor microwave ablation

The standard treatment of stage I nonsmall cell lung cancer is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I nonsmall cell lung cancer are not candidates for surgery due to severe medical comorbidities (poor cardiopulmonary function). Image-guided thermal ablation is an alternative for those patients, includes radiofrequency ablation, microwave ablation (MWA), cryoablation, and laser ablation. Compared to them, MWA is a relatively new technique with some potential advantages, such as faster heating times, higher intralesional temperatures, larger ablation zones, less procedural pain, relative insensitivity to "heat sinks," and less sensitivity to tissue types. However, some advantages of MWA mentioned above (such as higher intralesional temperatures, larger ablation zones) also have potential risks and problems, and an innovative and standardized guidance system is needed to avoid and solve these risks and problems. This article combs our team's clinical experience over the past decade, summarizes a systematic and standardized guidance system, and names it SPACES (Selection, Procedure, Assessment, Complication, Evaluation, Systemic therapy). Both primary and metastatic pulmonary tumors can be efficiently treated with image-guided thermal ablation in selected candidates. The selection and use of ablation techniques should consider the size and location of the target tumor, the risk of complications, and the expertise and skills of the professionals, among which the size of the target tumor (<3 mm) is a major factor determining the success of ablation.

Issues and prospects of image-guided thermal ablation in the treatment of primary and metastatic lung tumors

The precise local minimally invasive or noninvasive treatment represents the important orientation for advancing the treatment of pulmonary malignant tumors. New local treatment methods have emerged as solutions to the shortcomings of minimally invasive or local treatment methods. Image-guided thermal ablation (IGTA) comes with the characteristics such as more accurate localization, less trauma, more definite efficacy, higher safety, stronger repeatability, fewer complications, and lower cost in treating lung tumors. This paper investigates the existing problems of IGTA in the treatment of lung tumors and puts forward the orientation of studies.

Clinical guidelines for microwave ablation of spinal metastases

Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases.

Microwave ablation combined with cementoplasty under real-time temperature monitoring in the treatment of 82 patients with recurrent spinal metastases after radiotherapy

BACKGROUND

The spine is the most frequently affected part of the skeletal system to metastatic tumors. External radiotherapy is considered the first-line standard of care for these patients with spine metastases. Recurrent spinal metastases after radiotherapy cannot be treated with further radiotherapy within a short period of time, making treatment difficult. We aimed to evaluate the effectiveness and safety of MWA combined with cementoplasty in the treatment of spinal metastases after radiotherapy under real-time temperature monitoring.

METHODS

In this retrospective study, 82 patients with 115 spinal metastatic lesions were treated with MWA and cementoplasty under real-time temperature monitoring. Changes in visual analog scale (VAS) scores, daily morphine consumption, and Oswestry Disability Index (ODI) scores were noted. A paired Student's t-test was used to assess these parameters. Complications during the procedure were graded using the CTCAE version 5.0.

RESULTS

Technical success was attained in all patients. The mean VAS score was 6.3 ± 2.0 (range, 4-10) before operation, and remarkable decline was noted in one month (1.7 ± 1.0 [P < .001]), three months (1.4 ± 0.8 [P < .001]), and six months (1.3 ± 0.8 [P < .001]) after the operation. Significant reductions in daily morphine consumption and ODI scores were also observed (P < .05). Cement leakage was found in 27.8% (32/115) of lesions, with no obvious associated symptoms.

CONCLUSION

MWA combined with cementoplasty under real-time temperature monitoring is an effective and safe method for recurrent spinal metastases after radiotherapy.

Conservative surgery with microwave ablation for recurrent bone tumor in the extremities: a single-center study

BACKGROUND

Surgical treatment for recurrent bone tumors in the extremities still presents a challenge. This study was designed to evaluate the clinical value of microwave ablation in the treatment of recurrent bone tumors.

METHODS

We present 15 patients who underwent microwave ablation for recurrent bone tumors during the last 7 years. The following parameters were analyzed for outcome evaluation: general condition, surgical complications, local disease control, overall survival, and functional score measured using the Musculoskeletal Tumor Society (MSTS) 93 scoring system.

RESULTS

Percutaneous microwave ablation in one patient with osteoid osteoma and another with bone metastasis resulted in postoperative pain relief. Thirteen patients received intraoperative microwave ablation before curettage or resection, including those with giant cell tumors of bone (6), chondroblastoma (2), osteosarcoma (2), undifferentiated sarcoma (1), and bone metastases (2). All patients achieved reasonable local tumor control in the mean follow-up of 29.9 months. The functional score was 24.1 for the 15 patients 6 months after the operation. Four patients had tumor metastasis and died, whereas 3 patients with tumors survived, and the remaining 8 patients without the disease survived.

CONCLUSIONS

Microwave ablation represents an optional method for local control in treating recurrent bone tumors in the extremities.

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.

The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective

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.