Radiofrequency Ablation and Radiation Therapy Improve Local Control in Spinal Metastases Compared to Radiofrequency Ablation Alone

Abstract

Purpose: The spinal column is the most common location for osseous metastases and is associated with pain and decreased quality of life. This study evaluated combined radiofrequency ablation (RFA) with radiation therapy (RT) compared to RFA alone for improving pain and local control. Methods: This was a single-institution retrospective review of patients who underwent RFA of spinal metastases between 2016 and 2017, with or without RT to the same vertebral level. Pain was measured with visual analog scale at initial presentation and at 3 and 12 weeks of follow-up. Local failure (LF), distant failure, and overall survival (OS) were compared and Kaplan-Meier statistics were calculated. Results: Twenty-six patients with 28 spinal metastases were treated with RFA. Ten patients with 11 metastases were treated with RFA + RT. More patients with lung primaries were treated with RFA alone and more patients with breast primaries were treated with combination RFA+RT. There was no significant difference in pain scores between groups (P = .96). At a median follow-up of 8.2 months, LF was noted in 8 of 17 metastases treated with RFA alone compared to 1 of 11 metastases treated with RFA+RT (P = .049). There was a significant benefit in time to LF favoring RFA+RT (P = .02) and a significant benefit in OS (P = .0045). Conclusion: This study demonstrates a benefit in local control with RFA+RT versus RFA alone. Palliation of pain was effective using both regimens. This study was limited by a nearly unequal distribution of primary tumor histologies between groups. Literature regarding combined treatment of RFA and RT for spinal metastases is scarce and prospective protocols are warranted.

What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis

“…The 15 eligible studies involved a total of 725 patients. Only two studies were comparative in nature; Prezzano et al compared outcomes for RFA and cement augmentation versus RFA and radiotherapy[ 19 ] whereas Proschek et al compared RFA by itself to RFA with cement augmentation [ 28 ]. All other studies observed outcomes for one group all receiving the same RFA intervention.…”

“…Altogether, nine studies included pain data which could be statistically pooled for meta-analyses [ 18 , 19 , 21 – 24 , 26 , 27 , 31 ]. Though there was high methodological heterogeneity due to the serious risk of bias in non-randomised studies, the clinical diversity among these studies was quite similar as participants had similar ages, similar RFA systems being used and similar primary tumours.…”

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

“…Since radiation from electronic brachytherapy as part of Kypho-IORT is not only confined to the vertebral body but also of low energy (50 kV X-rays), it can be performed in any operating room suitable for c-arm fluoroscopy [22]. Combining kyphoplasty with radiofrequency ablation instead in regard of radioprotection is therefore not necessary and yielded inferior results in local control [5]. Previous findings showed that kyphoplasty with irradiation can be accomplished in an average time of 65 min and, due to its percutaneous approach, is a surgical intervention, but is considered minimally invasive [9,23].…”

“…Additionally, intraosseous hemangiomas frequently occur as benign tumors of the spine [2]. Treatment should focus on palliation of pain, stabilization and local tumor control with therapeutic options including radiation therapy, surgical intervention or radiofrequency ablation [3][4][5]. Due to continuous advancements in systemic cancer therapy, any delay or pause of systemic treatment caused by local interventions should be avoided.…”

The Pain Crisis: Interventional Radiology's Role in Pain Management

“…To our knowledge, no study has directly compared the effectiveness of RT and TA in treatment and palliation of osseous metastasis. However, a couple of studies report that the combination of the two modalities results in better local control and pain relief [43,44] than the two therapies used individually. Palliative TA for painful metastasis is indicated in patients with at least moderate pain that corresponds to the site of disease ( Fig.…”