The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases.

Claudio Pusceddu,Davide De Francesco,Alessandro Fancellu,Luca Melis,Nicola Ballicu

doi:10.3390/curroncol28050340

Abstract

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.

Highlights

The incidence of bone metastases in patients with cancer is extremely high: 84% for prostate, 72% for breast, 60% for thyroid, 37% for kidney, 33% for pancreas, and 31% for lung [1,2]
We found no difference in the visual analog scale (VAS) score over time from one week up to one year after Target Radiofrequency Ablation (tRFA) and Vertebral Augmentation (VA), suggesting that pain relief was immediate and durable
There was no difference in the VAS scores before and after surgery between the two groups of the study

Summary

Introduction

The incidence of bone metastases in patients with cancer is extremely high: 84% for prostate, 72% for breast, 60% for thyroid, 37% for kidney, 33% for pancreas, and 31% for lung [1,2]. Vertebral metastases occur in approximately 60–70% of patients with a primary tumor [3]. This high frequency of spine involvement can be due to the high hematopoietic activity and vascularization of the vertebrae [4]. Metastatic spinal lesions can involve one or two vertebrae or, in some cases, can affect multiple vertebrae.

Methods

Results

Conclusion