Treatment of Metastatic Spinal Lesions with a Navigational Bipolar Radiofrequency Ablation Device: A Multicenter Retrospective Study

Abstract

Background: Spinal metastatic lesions are a common occurrence among oncology patients and contribute to significant morbidity. Treatment options have been limited in their effectiveness and scope to this point. Objective: This study aims to report the safety and efficacy of radiofrequency ablation (RFA) of malignant spinal lesions using a novel RFA bipolar tumor ablation system which includes a navigational electrode containing 2 active thermocouples. Study Design: IRB approved multicenter retrospective review of patients receiving RFA as a treatment of metastatic osseous lesions between March 2012 and March 2013. Setting: This study consists of patients from 5 large academic centers. Method: One hundred twenty-eight metastatic lesions were identified in 92 patients who underwent a total of 96 procedures. Cement augmentation was performed when the vertebral body was at risk or had a pathological fracture. Visual analogue scale (VAS) scores were obtained preoperatively as well as postoperatively at the one week, one month, and 6 month time points. Interval change in the patients’ pain medications was recorded. Postoperative imaging was used to assess tumor burden at the treated level when available. Results: RFA was technically successful in all of the lesions without complication or thermal injury. Our study demonstrated significant (P < 0.01) decreases in the VAS scores at one week, one month, and 6 months postoperatively. In our largest center, 54% of our patients experienced a decrease and 30% had no change in their pain medications postoperatively. Sixtytwo percent of the spinal lesions in this largest institution were located in the posterior vertebral body. Post-ablation imaging confirmed size of ablation zones consistent with that measured by the thermocouples. Limitations: The main limitations of this study are the heterogeneous patient population, data set, and potential confounding variable of concurrent cement augmentation. Conclusion: The STAR System is an RFA device that was safely and effectively used in the treatment of spine metastatic osseous lesions. This new device allows RFA treatment of previously untreatable lesions with resultant reduction in pain that was not controlled by systemic or radiation therapy. Key words: Radiofrquency ablation, pain, osseous metastasis, spine, interventional oncology, oncology, pain management, tumor, vertebral augmentation

Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes

“…A total of 25 nonrandomized studies (21 retrospective, 4 prospective) published between 2008 and 2022 were included based on the inclusion/exclusion criteria (Supplementary Fig. 1) [5] , [15] , [16] , [17] , [19] , [20] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] . All included studies reported exclusively on metastatic spinal tumors.…”

Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study

“…Other musculoskeletal ablation studies had higher rates of previous radiation use or did not report the numbers [ 7 – 9 , 32 ]. Goetz reported 74% of patients were treated with radiation [ 9 ].…”

Microwave ablation versus radiofrequency ablation for treating spinal metastases

“…[25] 6.7 (±1.7) 3.2 (±1.4) P < .001 24 h 100% 1.4 (±1.3) P < .001 4 wk 1.1 (±0.8) P < .001 12 wk 1.0 (±0.7) P < .001 24 wk Chen et al [27] 6 (NA) 5 (NA) P < .05 3 d 86% 3 (NA) P < .05 1 mo 92% 3 (NA) P < .05 3 mo 92% 3 (NA) P < .05 6 mo 89% Zhang et al [28] 6.4 (±2. [30] 7.8 (±1.1) 3.5 (±2.0) P < .01 24 h NA Anchala et al [31] 7.51 (±2.46) 1.71 (±2.28) P < .0001 1 wk 54% 2.25 (±2.44) P < .0001 1 mo 1.75 (±2.62) P = .009 6 mo Zheng et al [32] 7.69 (±1.12) 6.62 (±1.02) P < .01 3 d NA 3.62 (±0.98) P < .01 1 mo NA 2.77 (±0.82) P < .01 3 mo NA Abdelgawaad et al [33] 7.2 (±2.3) 2.7 (±1.09) P = .0001 3 d NA 3 (±2.1) P = .0001 6 mo 83.3% Lv et al [34] 7. 52 [35] 8.…”

“…Three of the studies reported that no complications occurred in their cohorts. [24,31,32] Overall, the rest of the studies reported that 27.4% (n = 139) of patients receiving MWA reported complications, while 10.9% (n = 23) of patients receiving RFA had complications. MWA alone or in combination with surgery for spinal metastases has more major complications, including nervous system complications such as nerve injury, nerve function defect, persistent pain, pathological fracture, etc.…”

“…Motaghi et al [24] NA One year survival rate was 86%, 68% at 2 yr and 56%at 3 yr NA Wu et al [25] 97.0% NA Ten minor cement leakage (30.3%) Liu et al [26] 83.3% NA One major complications: nerve injury (8.3%) Chen et al [27] 94.8% NA One neural injury (1.1%) and 42 cement leakage (30.0%) Zhang et al [28] 98.0% Three patients died between 12 and 24 wk after the procedure Major complications: 1 pathologic fracture, 1 neurological deficit and 2 mild skin infection (2.0%), 69 cement leakage (34.8%) RFA Zhao et al [29] NA NA One cement leakage (6.3%) Cazzato et al [30] NA One patient died 3 wk later One grade 1 complication (9.1%) and 1 grade 6 complication (9.1%)* Anchala et al [31] NA NA No complication…”