Which Combination Treatment Is Better for Spinal Metastasis: Percutaneous Vertebroplasty With Radiofrequency Ablation, 125I Seed, Zoledronic Acid, or Radiotherapy?

Abstract

PVP combined with I seed exhibited the best clinical efficacy in terms of VAS, PVP combined with RT was the best choice in terms of WHO Pain Relief, and PVP combined with RFA showed the best effect in terms of ODI for the treatment of SM.

Potential Complications of Percutaneous Vertebroplasty Combined with Interstitial Implantation of 125I Seeds for Metastatic Spinal Tumors: A Case Report and Literary Review

“…Many factors such as the type of fracture, surgical technique, surgeon's experiences, suitable implanting location, and proper dose of 125 I particles are usually the key to increase the therapeutic efficacy of this combined surgery and reduce risks, especially the suitable implantation location and fitted dose of 125 I particles that may bring better therapeutic effectiveness and can avoid radioactive myelopathy, which have been emphasized in previous published literatures [6, 10, 12, 14, 15]. Thus, the surgeon should have skilled technique and rich experience of PVP.…”

“…After reviewing five related published clinical studies [6, 10, 12, 14, 15], the following seven main items of indications for PVP plus implantation of 125 I particles had been summarized (Figure 6). Firstly, the definite radiographic and physical evidences to confirm spinal metastasis were emphasized in five clinical studies [6, 10, 12, 14, 15]. Secondly, three literatures revealed that back pain with or without neck pain should be considered as the major clinical symptom [10, 14, 15].…”

“…Firstly, the definite radiographic and physical evidences to confirm spinal metastasis were emphasized in five clinical studies [6, 10, 12, 14, 15]. Secondly, three literatures revealed that back pain with or without neck pain should be considered as the major clinical symptom [10, 14, 15]. Thirdly, other indications are as follows: with more than 3 months of the estimated survival time [6, 10, 12], with normal function of main organs [10, 12], with ability of prone position (more than 2 hours) [10, 12], and without spinal cord or nerve compression [6, 14], which were presented in four published clinical studies.…”

Personalized Radiation Therapy in Cancer Pain Management

“…In case of spine metastases, combining percutaneous vertebroplasty (decreasing pain through restoring mechanical stability of vertebrae) with radiation therapy (exhibiting antitumor effect) provides better pain relief than radiotherapy alone [49] (Figure 3).…”

“…Several doses per fraction are used, from single 15–24 Gy fractions to 18–36 Gy delivered in 1–5 fractions [57,58,59,60,61,62]. Of note, data concerning efficacy and safety of the treatment come from retrospective analyses [46,47,48,49,50,51]. Nevertheless, SRS/SBRT is widely used in most radiation therapy centres.…”