Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients

Lane, Michael; Le, Huy; Lee, Steven; Young, Clint; Heran, Manraj K.S.; Badii, Maziar; Clarkson, Paul W.; Munk, Peter L.

doi:10.1007/s00256-010-1010-5

Cited by 128 publications

(71 citation statements)

References 32 publications

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“…Key questions were the severity of pain (night pain, daily pain, stress-related pain) assessed with a visual analog scale (VAS) from 0 (no pain) to 10 (worst imaginable pain) and patient satisfaction (from "completely not" to "limited" to "mostly and very satisfied"). We defined a reduction of >30% in the VAS score, no pain medication, and a patient satisfaction of at least "mostly satisfied" with a minimum time interval of three months after the RFA as long-term success (26). Failure was defined as the lack of significant pain reduction/persistent pain or a patient satisfaction worse than "mostly satisfied".…”

Section: Effectiveness Of Technique and Long-term Outcomementioning

confidence: 99%

CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features

Rehnitz¹,

Sprengel²,

Lehner³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to retrospectively evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) findings of patients with osteoid osteoma treated with CT-guided radiofrequency ablation (RFA) along with the clinical outcome and long-term success. MATERIALS AND METHODSSeventy-three CT-guided RFA procedures were performed in 72 patients. The long-term success was assessed using a questionnaire including several visual analog scale scores. The CT evaluation included pre-and immediate postprocedural imaging of all 72 patients, and MRI was performed in 18 patients with follow-up imaging (mean, 3.4±2.2 months). The evaluation criteria included nidus morphology and a correlation with markers of clinical success. RESULTSThe primary technique effectiveness rate was 71/72 (99%). One relapse was successfully retreated, leading to a secondary technique effectiveness rate of 72/72 (100%). The longterm follow-up (mean, 51.2±31.2 months; range, 3-109 months) revealed a highly significant reduction of all assessed limitation scores (P < 0.001). The CT morphology was typical in all cases and did not change during the short-term follow-up. The follow-up MRI patterns varied considerably, including persistent nidus contrast enhancement in one-third (6/18) and persistent marrow edema in half (9/18) of the patients. None of the investigated MRI and CT patterns correlated with the clinical outcome. CONCLUSIONThe long-term outcome of CT-guided RFA of osteoid osteoma is excellent. There is no correlation of the CT and MRI patterns with the clinical outcome. Thus, the treatment decisions should not be solely based on the imaging findings. Investigators should also be aware of the variety of imaging patterns after RFA.

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Section: Effectiveness Of Technique and Long-term Outcomementioning

confidence: 99%

CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features

Rehnitz¹,

Sprengel²,

Lehner³

et al. 2013

Diagn Interv Radiol

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“…1 Minimally invasive techniques that can destroy tumor cells using a BKP cannula or percutaneous vertebroplasty cannula for access, such as laserinduced thermal therapy, radiofrequency ablation, or photodynamic therapy, may prove viable options for this purpose. 1,13,22,24 While considering all of these options, it is important not to lose sight of the objectives involved in performing the BKP procedure-that is, the pain relief obtained by stabilizing a metastatic vertebral fracture by using a minimally invasive technique.…”

Section: Discussionmentioning

confidence: 99%

Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease

Cruz

Sahgal

Whyne

et al. 2014

SPI

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Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral compression fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new fractures at adjacent levels. Although the potential for “tumor extravasation” has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.

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“…Desde el punto de vista clínico, los resultados son buenos con mejoría del dolor en las primeras 24 horas en todos los pacientes, resultados similares a los obtenidos por otros autores (8)(9)(10)(11)(12)(13). En lo relativo a los aspectos técnicos, la combinación de ambas técnicas no incrementa la complejidad del procedimiento ya que el acceso transpedicular empleado, para la realización de la cifoplastia, es el mismo que se requiere para la realización de la RF previa, con la excepción de que el acceso óseo inicial para efectuar la ablación se realizó con agujas de 11G, que posteriormente se intercambian por el sistema de acceso de cifoplastia.…”

Section: Figunclassified

“…Estudios recientes sugieren que los tratamientos percutáneos, mínimamente invasivos, pueden contribuir al manejo de estos pacientes (3,4,(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionunclassified

Experiencia preliminar en el tratamiento combinado de metástasis vertebrales mediante radiofrecuencia y cifoplastia en sesión única

Buitrago

Castro

Garrido

et al. 2013

Rev. Soc. Esp. Dolor

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Experiencia preliminar en el tratamiento combinado de metástasis vertebrales mediante radiofrecuencia y cifoplastia en sesión única G. Buitrago, E. Castro, J. C. Garrido, P. Fernández-García, J. ABSTRACTObjectives: Describe our preliminary experience in the treatment of vertebral metastases by radiofrequency and Kyphoplasty combined in one single session.Material and methods: Four patients with histologically confirmed single spinal metastasis (breast, prostate, lung and myeloma in L1, L5, D12, D12, respectively) were treated. The indication in all cases was pain with a poor response to medical treatment. All patients had pain in the range 6-7 visual analogue scale (VAS). In two cases there was a lytic lesion of the spinal posterior wall. After obtaining informed consent, and under sedation and local anesthetic the procedure took place. The transpedicular approach took place with a 11 G bone puncture system. Two radiofrequency needles were coaxially inserted to carry out an ablation cycle through each pedicle. During the ablation cycle the tip of the ablation neddle stood between the anterior and middle third of the vertebral body, while the second needle was used as thermal sensor with its end to the height of the vertebral posterior wall. The duration of each cycle of ablation was 8 minutes reaching intratumoral temperatures of 70-80 °C. Transpedicular Kyphoplasty was performed subsequently.Results: No complications were reported during or after the procedure and patients were discharged in the first 24 hours. There was an immediate improvement in pain after the procedure (with a VAS 1-2 intensity pain) in all patients. During follow up, analgesic medication was withdrawn in three patients, and there was no evidence of disease progression or recurrence of pain (pain intensity 1 (VAS) in a follow-up in the range of 8-14 months). Clinical and radiological follow-up after discharge could not be performed on a patient.Conclusion: The use of radio-frequency associated with Kyphoplasty in vertebral metastatic disease can contribute to the management of refractory pain to medical treatment.Key words: Vertebral metastases. Radiofrequency. Kyphoplasty. RESUMENObjetivos: Describir nuestra experiencia preliminar en el tratamiento de metástasis vertebrales mediante radiofrecuencia y cifoplastia combinadas en sesión única.Material y métodos: Se trataron cuatro pacientes con metástasis vertebral única confirmada histológicamente (mama, próstata, pulmón y mieloma en D12, L1, L5 y D12, respectivamente). La indicación en todos los casos fue el dolor con una mala respuesta al tratamiento médico habitual. Todos los pacientes presentaban dolor en el rango 6-7 de la escala visual analógica (EVA). En dos casos existía lesión lítica del muro posterior. Tras la obtención del consentimiento informado se realizó el procedimiento bajo sedación e infiltración anestésica local. Se efectuó abordaje transpedicular bilateral con sistemas de punción ósea 11G. Se insertaron de forma coaxial dos agujas de radiofrecuencia para efectuar un ciclo...

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Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients

Abstract: Combined RFA and cementoplasty appears to be safe, practical and effective in the palliative treatment of painful neoplastic lesions.

Cited by 128 publications

References 32 publications

CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features

CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features

Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease

Experiencia preliminar en el tratamiento combinado de metástasis vertebrales mediante radiofrecuencia y cifoplastia en sesión única

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