Combined microwave ablation and minimally invasive open decompression for the management of thoracic metastasis in breast cancer

Abstract

ObjectiveThe incidence rate of thoracic metastasis from breast cancer is increasing. Microwave ablation is one type of clinical therapy used to treat metastatic spine disease, although it can cause protein denaturation and immediate cell death, and coagulative necrosis can occur. Minimally invasive open decompression is associated with lower rates of surgical complications in comparison to traditional open surgery. Therefore, it is an alternative therapeutic option for spinal metastases. This study aimed to assess the efficacy of microwave ablation with minimally invasive open decompression in the management of breast cancer patients with thoracic metastasis.MethodsThis single-institution retrospective study investigated 23 cases of thoracic metastasis from breast cancer treated with combined microwave ablation and minimally invasive open decompression. Patients that presented with indications for surgery underwent surgical treatment. Data were collected for pain scores, the Frankel Grade classification system for acute spinal injury, the Karnofsky performance status (KPS) scale and complications due to treatment.ResultsOf the 23 patients included in this study, all were successfully treated with microwave ablation and minimal invasive open decompression using our metrics. Of those, 18 patients (78.3%) showed improvement in their KPS results while 5 (21.7%) had alleviation of KPS. All 23 patients showed improvement in their Frankel Grade, suggesting improved neurological function following surgery. Most of the patients reported pain relief. Postoperative complications occurred in 4 patients.ConclusionMicrowave ablation combined with minimally invasive open decompression therapy for breast cancer patients with thoracic metastatic tumors is an alternative treatment that maintains or improves functional outcome in comparison to open surgery.

Use of percutaneous microwave ablation for the treatment of bone tumors: a retrospective study of clinical outcomes in 47 patients

“…Recently, Cheng et al [34] have shown that ultrasound-guided percutaneous MWA has the advantages of being a real-time, convenient, lower-cost and nonradiative treatment; additionally, complications related to thermal damage (in the form of skin burns), infection and nerve injury did not occur in any patients. Other recent and mostly retrospective studies have shown the same results, with a relatively low rate of complications [11, 15, 16, 21, 22]. Similarly, the results of our study also indicate that MWA is a safe and efficient approach, with only three minor complications related to thermal injury that caused myofasciitis and affected wound healing in the entire study.…”

“…Percutaneous MWA techniques have been used for the treatment of patients with several benign and metastatic bone lesions, and major complications are infrequent [6, 15–17, 21, 22, 27, 33, 34]. Kastler et al [27] reported the successful treatment of spinal metastases with MWA, without any major complications.…”

“…Compared with other heat-based therapies, this method presents a shorter ablation time, a higher ablation temperature, and a larger ablation zone [11]. In particular, clinical studies have shown that MWA results in lower sensitivity to variations in tissue composition, tissue carbonization and bone impedance, with the advantage that MWA may penetrate tissue more than RFA, to better treat bone tumors with high impedance, such as osseous metastases [12–15].…”

The effects of combined microwave ablation and open surgery for the treatment of lung cancer‐derived thoracolumbar metastases

“…12,27,28 Khan et al 27 reported a dramatic reduction of the pain score after percutaneous MWA and cementoplasty in 84 thoracolumbar sites of painful spinal metastases and myeloma. Liu et al 14,15 demonstrated that MWA combined with open decompression surgery for patients with breast cancer-derived thoracic metastatic tumors is an effective treatment that maintains or improves functional outcomes better than open surgery. However, Kastler et al 28 did not use cement augmentation combined with MWA and reported moderate pain improvement.…”

“…MWA with open decompression therapy in 23 patients with breast cancer-derived thoracic metastases showed that 78.3% of them improved their score. 15 However, these two findings were from retrospective studies without a control group and a limited sample size. Zhang et al 16 showed that applying MWA in 69 patients with pathological spinal fractures had more advantages in alleviating pain and improving the quality of life when combined with decompression and pedicle screw fixation than not performing MWA.…”