Klinische Aspekte zur Problematik der Wirbelkörpermetastasen, Möglichkeiten moderner Behandlungsmethoden unter besonderer Berücksichtigung der Radiofrequenzablation

Abstract

From 100,000 people in Germany, statistically calculated, 441 males and 350 females suffer from a cancer disease. In about 50 to 80 % of patients with breast or prostate carcinoma bone metastases are registered, which is connected, among others, with a high risk for pathological fractures and other debilitating diseases. The diagnosis of bone metastases is done by conventional X-ray equipment, CT, MRI, and especially with the help of skeletal scintigraphy. For therapy bisphosphonates, anti-hormones and chemotherapeutic agents as drugs are used. Furthermore, radiotherapy, radionuclides, surgery and ablative procedures are applied. A more recent technical method is the STAR™ Tumour Ablation System (RFA), by which minimally invasively an electrode is introduced into the vertebral bodies. The system ensures precise control and thus a targeted ablation of the metastases. Several publications and reports describing a combined application demonstrate the synergistic effectiveness of RFA and radiofrequency kyphoplasty.

Radiofrequency Ablation: Temperature Distribution in Adjacent Tissues

“…There were higher ablation temperatures in the cadaveric model than in the in vivo animal model [23,24]. The SpineSTAR Tumor Ablation System is the first navigable radiofrequency ablation system that is specifically approved for the treatment of tumour metastases in vertebral bodies [18]. In the present study, the temperature of the SpineSTAR probe measured during ablation was not much higher than 37°C and was therefore within the physiological range for the human body.…”

“…As a result, there is a major risk of uncontrolled current flow that can lead to thermal damage of the surrounding tissue. In bipolar systems, the current flow is spatially restricted to the treatment area and this restricts the risk of damage to the surrounding tissue [18]. Moreover, both the efficiency of the ablation and the risk of thermal damage to the surrounding tissue depends on tissue type and tumour localisation.…”

Radiofrequenzablation: Temperaturverteilung im angrenzenden Gewebe

“…Dadurch entsteht ein hohes Risiko eines unkontrollierten Stromflusses, der zu thermischen Schädigungen des umliegenden Gewebes führen kann. Bei bipolaren Systemen ist der Stromfluss räumlich auf das Behandlungsgebiet begrenzt, wodurch sich das Risiko einer Schädigung des umliegenden Gewebes verringert [18]. Zudem ist sowohl die Effizienz der Ablation als auch das Risiko für thermische Schädigungen des umliegenden Gewebes vom Gewebetyp und der Lokalisation des Tumors abhängig.…”

“…Das SpineSTAR-Tumorablationssystem ist das erste speziell für die Behandlung von Tumormetastasen im Wirbelkörper zugelassene navigierbare Radiofrequenzablationssystem [18]. Die in dieser Studie während der Ablation gemessene Temperatur der SpineSTARSondewar nichtwesentlich höher als 37°C und bewegte sich daher innerhalb der physiologischen Temperaturspanne des menschlichen Körpers.…”