Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety

Cazzato, Roberto Luigi; Garnon, Julien; Caudrelier, Jean; Rao, Pramod; Koch, Guillaume; Gangi, Afshin

doi:10.1080/02656736.2018.1425918

Cited by 38 publications

(37 citation statements)

References 29 publications

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“…Furthermore, the purposes for spinal metastasis treatment are usually different from visceral metastases, which makes the treatment concept, preoperative evaluation, and treatment strategy of spinal metastasis become irregular and arbitrary. At the same time as the rapid development of immuno‐therapy, endocrine therapy, radiotherapy, and chemotherapy (especially targeted therapy), a multidisciplinary combined therapy of spinal metastasis has become a trend. Therefore, indications and contraindications for spinal metastasis surgery treatment should be clearly understood.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Yang

Wang

Zhang

et al. 2019

Orthopaedic Surgery

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ObjectivesTo summarize the epidemiological characteristics of patients following surgery for spinal metastases retrospectively and make a univariate analysis to identify independent variables that could affect the operation decision making.MethodsThis was a multicenter retrospective review of patients with spinal metastasis who were treated with surgery from 1 January 2007 to 31 July 2019. Basic clinical data were analyzed retrospectively by univariate analysis to identify independent variables that could affect the decision of operation modalities, including gender, age, spinal metastatic site, Frankel score, Karnofsky performance score (KPS), spinal instability neoplastic score (SINS), visual analogue scale (VAS), Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, primary tumor, extraspinal metastasis, visceral metastasis, and bone lesion (osteolytic, osteoblastic or mixed).ResultsA total of 580 patients including 332 males and 248 females were enrolled in the study with an average age of 58.26 years old (range, 13–86 years old). The most common spinal metastatic level was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), and sacral vertebra (35 [6.03%]). Metastases involving more than two sites of the cervical, thoracic, lumbar, and sacral vertebrae arose in 162 (27.93%) patients. For primary tumor, there were 198 (34.14%) cases of lung cancer, 41 (7.07%) cases of kidney cancer, 39 (6.72%) cases of breast cancer, 38 (6.55%) cases of gastrointestinal cancer, 35 (6.03%) cases of lymphoma and myeloma, 25 (4.31%) cases of prostate cancer, 24 (4.14%) cases of liver cancer, 23 (3.97%) cases of mesenchymal tissue sarcoma, 20 (3.45%) cases of thyroid cancer, and 84 (14.48%) cases were tumor with unknown origin. Sixty‐three (10.86%) patients received minimally invasive surgery, 460 (79.31%) patients received palliative surgery, and the remaining 57 (9.83%) received tumor resection. According to the univariate analysis, the KPS score, SINS score, VAS score, Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, and bone lesion (osteolytic, osteoblastic or mixed) were independent and favorable factors affecting the surgery modalities.ConclusionsSurgical treatment for spinal metastases was mainly to relieve pain, rebuild spinal stability, improve nerve function, control local tumors, and improve the quality of life of patients. For middle‐aged and elderly patients with good general conditions, severe pain, spinal pathological fracture, spine instability and without urinary and fecal incontinence, early surgical treatment should be actively carried out.

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Section: Introductionmentioning

confidence: 99%

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Yang

Wang

Zhang

et al. 2019

Orthopaedic Surgery

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“…Radiofrequency ablation allows for targeted destruction of the metastatic deposit and vertebral augmentation allows for stabilisation of the vertebra prevent future pathological fracture. Several studies have prove percutaneous radiofrequency ablation to be a safe technique which can be extremely effective at achieving analgesia in patients with painful spinal metastases [12]. Most recent studies have combined radiofrequency ablation with vertebral augmentation [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Metastatic Melanoma Epidural Tumour Regression Following Percutaneous Radiofrequency Ablation

Papanikitas

Fairhead

Chekroud

et al. 2020

Cureus

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Percutaneous radiofrequency ablation of spinal metastases is an emerging treatment for patients with painful metastatic spine disease. It is typically performed for patients who have not responded to conventional treatments or who have contraindications to radiotherapy. Destruction of the posterior wall of the vertebral body and epidural disease may be considered relative contraindications for radiofrequency ablation. This is due to the difficulty in achieving satisfactory ablation balanced against the risk of neural injury. We describe a case of metastatic melanoma with an expansile lytic metastasis and epidural tumour extension at the L4 vertebral body level resulting in severe central canal stenosis. This was successfully treated with percutaneous radiofrequency ablation and vertebral augmentation. The patient reported significant pain relief post-procedure and follow-up MRI at two months demonstrated local tumour regression, epidural disease resolution and improved spinal canal dimensions. To the best of our knowledge, this is the first report of epidural disease resolution from metastatic melanoma following radiofrequency ablation and emphasises the potential benefits of ablation therapy even in the presence of canal stenosis and epidural metastatic disease.

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“…Additionally, compared to the other non-percutaneous techniques such as RT and MRgFUS, percutaneous ablation offers the advantage of combining bone consolidation with ablation within the same intervention, thus significantly reducing the risk of secondary fracture at the treated site. Such combined approach, which is a common practice for interventional radiologists [31], allows rapid patient's mobilization [34][35][36][37] and optimal pain control, which can be additionally improved if RT is added [12]. This possibility of combining ablation and consolidation represents a major advantage of percutaneous locoregional treatments over non-percutaneous techniques, particularly SBRT, which results in secondary fractures in 9-11% cases [23].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, minimally-invasive percutaneous image-guided locoregional treatments [5,8,9] have been introduced for the treatment of BM. In particular, in the past two decades, radiofrequency-(RFA) and cryo-ablation (CA) have been successfully applied for the symptomatic treatment of painful BM [10][11][12][13]; and to a lesser extent, both these techniques have also been used with a curative intent [14,15] as an alternative to the surgery or radiation therapy (RT).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients

Cazzato

Auloge

Marini

et al. 2018

International Journal of Hyperthermia

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Introduction: Percutaneous image-guided cryo-(CA) and radiofrequency-(RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. Materials and Methods: This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. Results: Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N ¼ 37; 75,5%) or RFA (N ¼ 12; 24,5%). Primary malignancies included thyroid (N ¼ 11, 22.5%), breast (N ¼ 21; 42.9%), lung (N ¼ 8; 16.3%) and other (N ¼ 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N ¼ 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N ¼ 14); 1-and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p ¼ .002). Conclusions: Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM 2 cm.

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Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety

Abstract: RFA, combined with vertebral augmentation in most of the cases, is effective and safe in achieving short- to mid-term (from 1 week to 6 months) analgesia in patients affected by painful spinal metastasis.

Cited by 38 publications

References 29 publications

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Metastatic Melanoma Epidural Tumour Regression Following Percutaneous Radiofrequency Ablation

Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients

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