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.
Purpose To evaluate the efficacy and safety of computed tomography (CT)-guided 125I seed implantation by coplanar template for vertebral metastases after failure of external beam radiation therapy. We also want to compare the dosimetry of 3D printed coplanar template-assisted interstitial 125I brachytherapy preoperative and postoperative, and to explore the accuracy of this technology. Material and methods We retrospectively collected and analyzedthe results of 56 patients with vertebral metastases after failure of external beam radiation therapy, who underwent interstitial 125I brachytherapy as a salvage treatment with a CT-guided coplanar template-assisted technique from January 2015 to January 2017. Results The NRS score for worst pain was 6.1 ± 1.1 before 125I seed implantation. The mean posto-perative NRS score decreased significantly at T4w (3.5 ± 0.9, p < 0.01), T8w (2.1 ± 0.9, p < 0.01), T12w (1.5 ± 0.7, p < 0.01) and T6m (1.2 ± 0.6, p < 0.01) respectively. There was no significant difference in scores among T0, T24h (P = 0.10) and T1w (P = 0.09). The local control rates after 3, 6, 9 and 12 months were 100% (58/58), 92.5% (49/53), 90.2% (46/51), and 85.1% (40/47), respectively. By performing paired t-test analysis, there were no significant differences in D90, D100, V90, V100, V150, V200, GTV volume, CI, EI and HI between preoperative and postoperative(p༞0.05). Postoperative D90 was an independent influencing factor of local control time (HR: 1.047, 95% CI: 0.998–1.098, p = 0.043). The optimal Cut-off value of postoperative D90 was 130 Gy. Conclusions Interstitial 125I seed implantation can be used as a salvage treatment forpatients with vertebral metastases after failure of external beam radiation therapy. With the auxiliary function of 3D printed coplanar template, the main dosimetry parameters verified after the operation can meet the requirements of the preoperative plan with good treatment accuracy.
PurposeTo evaluate the efficacy safety of computed tomography (CT)-guided 125I seed implantation by coplanar template for vertebral metastases after failure of external beam radiation therapy (EBRT).Material and methodsRetrospective analysis of the clinical outcomes of 58 patients with vertebral metastases after failure of EBRT, who underwent 125I seed implantation as a salvage treatment with a CT-guided coplanar template-assisted technique from January 2015 to January 2017.ResultsThe mean post-operative NRS score decreased significantly at T4w (3.5 ± 0.9, p<0.01), T8w (2.1 ± 0.9, p<0.01), T12w (1.5 ± 0.7, p< 0.01) and T6m (1.2 ± 0.6, p< 0.01) respectively. The local control rates after 3, 6, 9 and 12 months were 100% (58/58), 93.1% (54/58), 87.9% (51/58), and 81% (47/58), respectively. The median overall survival time was 18.52months (95% CI, 16.24-20.8), and 1- and 2-year survival rates were 81% (47/58) and 34.5% (20/58), respectively. By performing a paired t-test analysis, there was no significant difference in D90, V90, D100, V100, V150, V200, GTV volume, CI, EI and HI between preoperative and postoperative (p>0.05).Conclusions125I seed implantation can be used as a salvage treatment for patients with vertebral metastases after failure of EBRT.
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