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Capek L, Henys P, Barsa P, Dvorak V. Performance of radiofrequency ablation used for metastatic spinal tumor: Numerical approach. Proc Inst Mech Eng H 2017; 231:814-820. [PMID: 28486874 DOI: 10.1177/0954411917706250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Surgical treatment of spine metastases follows only local anatomical and biomechanical objectives. Few cases of actual solitary metastases are rather exceptional, while removal of these metastases and the primary tumor may help to eradicate the process. The aim of our subsequent numerical simulations was to find out the temperature distribution and the volume lesion in a spinal tumor. For this purpose, the parametric three-dimensional numerical model was developed. It was shown that by finite element modeling approach not only the temperature distribution but even the resulted cavity may be estimated. The numerical approach was shown as a strong tool in surgery planning.
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Affiliation(s)
- Lukas Capek
- 1 Department of Textile Technologies, Technical University of Liberec, Liberec, Czech Republic
| | - Petr Henys
- 1 Department of Textile Technologies, Technical University of Liberec, Liberec, Czech Republic
| | - Pavel Barsa
- 2 Department of Neurosurgery, Regional Hospital of Liberec, Liberec, Czech Republic
| | - Vaclav Dvorak
- 3 Department of Power Engineering Equipment, Technical University of Liberec, Liberec, Czech Republic
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Pezeshki PS, Davidson SR, Akens MK, Murphy K, McCann C, Sherar M, Whyne CM, Yee AJM. Helical coil electrode radiofrequency ablation designed for application in osteolytic vertebral tumors--initial evaluation in a porcine model. Spine J 2015; 15:1832-40. [PMID: 25819585 DOI: 10.1016/j.spinee.2015.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiofrequency ablation (RFA) is emerging as a complementary treatment for vertebral metastases. Traditional RFA induces frictional heating leading to local tissue necrosis but often yields small, incomplete, and inhomogeneous zones of ablation in bone. We have developed a new bone-specific RFA electrode that uses a nontraditional frequency (27.12 MHz) and geometry (helical), exploiting a magnetic field and an electric field to generate larger and more comprehensive treatment zones. PURPOSE The purpose of the study was to evaluate the feasibility and safety of the Bone Coil RFA electrode in the spine. STUDY DESIGN This is a preclinical in vivo study based on basic science. METHODS Under institutional approval, six healthy Yorkshire pigs received a sham and an RF treatment in two adjacent cervical vertebrae. To deploy the Bone Coil RFA device in dense porcine vertebrae, a surgical approach was required; an irrigated coring drill bit created a cylindrical path in the vertebral bodies through which the RFA electrodes were placed. The electronic circuit was completed by four grounding pads. Treatment was delivered for 10 minutes at 20 W (n=1), 25 W (n=1), and 30 W (n=4). To monitor the thermal rise and for safety, fiber-optic probes recorded temperatures in the center of each coil and near the spinal foramen. After the procedure, animals were monitored for 2 weeks. Magnetic resonance imaging (MRI) was completed immediately after treatment and at 14 days. Magnetic resonance image segmentation and histology were used to evaluate the ablation volume. RESULTS Comprehensive treatment of the porcine vertebrae was demonstrated by temperature monitoring, MRI, and histology. Large zones of RF ablation were obtained (RF: 3.72±0.73 cm3 vs. sham: 1.98±0.16 cm3, p<.05), confined within the vertebral body. Internal temperatures were elevated with RF (66.1 °C-102.9 °C), without temperature rise outside of the vertebrae (38.2 °C ± 1.5 °C). Mobility, neurological responses, and behavior were normal, consistent with preprocedural examination. Magnetic resonance imaging best visualized ablation at Day 14. Histology revealed comprehensive homogeneous coagulative necrosis with little peripheral sign of repair. CONCLUSIONS The Bone Coil RFA device created large intravertebral ablation volumes with no neurologic sequelae. Radiofrequency thermal ablation (clearly distinguished from the much smaller effects arising from core drilling) corresponded to the homogeneous necrosis visible on histology.
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Affiliation(s)
- Padina S Pezeshki
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Sean R Davidson
- Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Margarete K Akens
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Kieran Murphy
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Claire McCann
- Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Michael Sherar
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Techna Institute, University Health Network, 124-100 College St, Toronto, Ontario M5G 1P5, Canada
| | - Cari M Whyne
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada
| | - Albert J M Yee
- Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Rosebrugh Building, RM 407 164 College St, Toronto, ON M5S 3G9, Canada; Sunnybrook Health Sciences Centre 2075 Bayview Ave, Room MG 371B Toronto, ON M4N 3M5, Canada.
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Safari M, Khoshnevisan A. An overview of the role of cancer stem cells in spine tumors with a special focus on chordoma. World J Stem Cells 2014; 6:53-64. [PMID: 24567788 PMCID: PMC3927014 DOI: 10.4252/wjsc.v6.i1.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 08/31/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Primary malignant tumors of the spine are relatively rare, less than 5% of all spinal column tumors. However, these lesions are often among the most difficult to treat and encompass challenging pathologies such as chordoma and a variety of invasive sarcomas. The mechanisms of tumor recurrence after surgical intervention, as well as resistance to radiation and chemotherapy, remain a pervasive and costly problem. Recent evidence has emerged supporting the hypothesis that solid tumors contain a sub-population of cancer cells that possess characteristics normally associated with stem cells. Particularly, the potential for long-term proliferation appears to be restricted to subpopulations of cancer stem cells (CSCs) functionally defined by their capacity to self-renew and give rise to differentiated cells that phenotypically recapitulate the original tumor, thereby causing relapse and patient death. These cancer stem cells present a unique opportunity to better understand the biology of solid tumors in general, as well as targets for future therapeutics. The general objective of the current study is to discuss the fundamental concepts for understanding the role of CSCs with respect to chemoresistance, radioresistance, special cell surface markers, cancer recurrence and metastasis in tumors of the osseous spine. This discussion is followed by a specific review of what is known about the role of CSCs in chordoma, the most common primary malignant osseous tumor of the spine.
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Yoon BC, Molina C, Gokaslan ZL, Sciubba DM. Metastatic spine disease in the elderly: diagnostic and management considerations. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Metastatic spine disease is becoming a more frequent problem in cancer patients as advancements in treatment for primary tumors prolong patient survival. Elderly patients over 60 years of age make up the majority of these cases, with the incidence of metastatic disease several folds higher in the elderly than in any other age group. These patients are also the most challenging group to treat, given higher rates of comorbidities and decreased tolerance to medical, surgical and radiation therapies. Advancements in therapeutic strategies, including minimally invasive surgeries and stereotactic radiosurgery, have provided increasingly attractive treatment options for elderly patients owing to their decreased procedure-associated morbidity. This article will discuss efficacy and limitations of conventional, as well as more recent, treatment modalities with an emphasis on their role in the management of elderly patients.
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Affiliation(s)
- Byung C Yoon
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Camilo Molina
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Ziya L Gokaslan
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
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