Painful Metastases Involving Bone: Percutaneous Image-guided Cryoablation—Prospective Trial Interim Analysis

Callstrom, Matthew R.; Atwell, Thomas D.; Charboneau, J. William; Farrell, Michael; Goetz, Matthew P.; Rubin, Joseph; Sloan, Jeff A.; Novotny, Paul J.; Welch, Timothy J.; Maus, Timothy P.; Wong, Gilbert Y.; Brown, Kathy J.

doi:10.1148/radiol.2412051247

Cited by 213 publications

(131 citation statements)

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“…Cryotherapy, for example, performed at very low temperatures, is very labour intensive, a complete metastases removal is predominantly impossible and there is a substantial risk of damaging healthy tissue. [1,2] Laser therapy occurs at higher temperatures locally with 500…”

Section: Discussionmentioning

confidence: 99%

“…Further operational risks, above all blood loss, complications and surgical times are considerably reduced. [1,17,18,[29][30][31] We have combined the method with balloon kyphoplasty [21][22][23] with custom-made extremely thin trocars to allow for Fracture reposition and Kyphosis reduction with the bone cement application for vertebra stabilisation and for filling the defect. The plasma probe is pre-bent and can be rotated meaning the ablation was done in multiple directions under permanent control using X-ray in 2 projections during the surgery.…”

Section: Description Of Cavity/coblation-methodsmentioning

confidence: 99%

“…(1) Cryotherapy operates at a very low temperature, is very labour intensive, is unable to remove all metastatic tissue completely and is highly likely to damage healthy tissue. [1,2] (2) Thermo-/laser therapy operates at higher temperatures, locally at 500…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Dabravolski¹,

Eßer²,

Lahm

et al. 2016

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Background: Tumours and metastases of the spine are extremely stressful for patients. A radical surgery of metastases of the spine is not possible in many cases. Especially higher risk elder multimorbid patients are at risk. The therapeutic goals are always: small invasiveness, high efficiency of tumour removal, fracture repositioning, stabilisation, pain reduction, improving the patient's life quality. The specialness and difficulties of the diagnosis and therapy with the Cavity/Coblation-method the operative technique, results of the treatment of more than 274 patients with vertebral body tumours/metastases is going to be presented. Materials and methods: Patients: Patients of every age with destruction were treated: with osteolysis, Fractures of the spine caused by spinal tumours and metastases. Diagnosis preoperatively was evaluated through X-Ray, MRT, CT, complete body PET, histology. Cavity/Coblation method: The tumour tissue resection in the vertebra was carried out by the plasma field (T 42• C, cold energy) over the percutaneous transpedicular or extrapedicular access and was followed by vertebroplasty or balloon kyphoplasty with PMMA bone cement. This was followed up with clinical and radiological examinations, including data concerning pain and improvement of life quality after 2, 14 days as well as 3, 6, 12, 24, 36, 48 and 60 months postoperatively. Results: Within 6 years (03/08-04/14) more than 274 patients (171 female, 103 male, age range of 31-92 y. old average age of 65.7) or 895 vertebral bodies with tumours or metastases were treated. In 61 cases of 274, dorsal percutaneous instrumentation und straightening was an additional treatment. A small amount of blood loss and a very low complication rate was recorded. Postoperatively was shown by all patients an obvious reduction of pain, increase in life quality, satisfaction with the operative result, rapid mobilization was possible as well as the immediate radiation and chemotherapy for reduction of the local tumour recurrence rate. The complications were as follows: in 39 cases of 274 a cement leakage occurred laterally or in the intervertebral disc space without clinical relevance. 194 patients (105 women, 89 men) are now deceased due to tumour manifestations. Conclusions: Coblation/Cavity has shown itself to be a safe, minimal invasive procedure with good short and long term results, a low complication rate, blood loss and short surgery times. The total local recurrence rate for all patients with spine metastases in the study was in 35 from 250 cases/patients with metastasen or only in 14.0%. Following things are important: a comprehensive diagnostic including tumour staging, correct indication, prognostic assessment and precise surgical technique. The method bears much promise for the future.

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Section: Discussionmentioning

confidence: 99%

Section: Description Of Cavity/coblation-methodsmentioning

confidence: 99%

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Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Dabravolski¹,

Eßer²,

Lahm

et al. 2016

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“…Recent literature has also shown benefit in palliating painful bony and extra-abdominal soft-tissue metastases using percutaneous image-guided cryoablation. 7,8 Benefits of this minimally invasive treatment option include the absence of a surgical scar, reduced recovery time, and the ability to visualize the treated tumor both during and immediately after the procedure to determine treatment success. Probe diameters have also decreased in recent years, further making use of this technique to other sites of disease safer and easier with less postprocedural bleeding.…”

Section: Discussionmentioning

confidence: 99%

Solitary Fibrous Tumor of the Buccal Space: Treatment with Percutaneous Cryoablation

Schirmang¹,

Davis²,

Nigri³

et al. 2007

American Journal of Neuroradiology

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SUMMARY:Solitary fibrous tumors are rare spindle cell neoplasms that typically occur in the thorax but have been described in various locations within the abdomen and head and neck region. The most common extrapleural site is the oral cavity, but these tumors have been also described in the orbit, nasopharynx, paranasal sinuses, salivary glands, and larynx. [1][2][3] We describe a case of a solitary fibrous tumor of the buccal space successfully treated with percutaneous CT-guided cryoablation.A 64-year-old woman was referred to our tumor ablation service with a complaint of progressive left facial swelling. The patient is from Puerto Rico and underwent an excisional biopsy of a left buccal space mass via a transoral approach approximately 1 year before presentation. A solid, encapsulated soft-tissue tumor was found intraoperatively. There was disruption of the capsule during removal, preventing complete excision. Pathology demonstrated a World Health Organization low-grade solitary fibrous tumor (SFT) of the buccal space with 2-3 mitotic cells per 10 high-power fields, which was CD34 ϩ on immunohistochemical staining. Physical examination at current presentation revealed a firm, mobile, and nontender mass in the left malar soft tissues resulting in facial asymmetry. There was no numbness or facial paralysis. The overlying skin appeared normal. Oropharyngeal examination revealed no evidence of ulceration. Facial CT scan showed an enhancing mass within the left buccal space, which appeared isoattenuated to muscle. There was no calcification or necrosis, nor was there bony destruction of the mandible or maxilla. MR imaging at 0.3T revealed a well-circumscribed solid mass measuring 2.6 ϫ 3.2 ϫ 1.7 cm that was separate from the masseter muscle and that displaced the parotid duct and facial vein medially. The mass was isointense compared with muscle on T1-weighted precontrast images and was heterogeneous in appearance on T2-weighted sequences, containing areas of hyperintensity and hypointensity. There was homogeneous strong enhancement, most consistent with a presumed residual or recurrent SFT (Fig 1). The patient declined surgical reexcision because of the risk of facial nerve injury and for cosmetic reasons and, therefore, elected to have this lesion treated with percutaneous thermal ablation.Written, informed consent was obtained from the patient before the start of the procedure. Coagulation parameters were normal. Percutaneous cryoablation was performed in the supine position via a left transmalar approach with local anesthesia and moderate sedation using intravenous midazolam hydrochloride and fentanyl. CT fluoroscopy was used for imaging guidance. Cryoablation was performed with an argonbased cryoablation system (Endocare, Mountain View, Calif) with 1.7-mm-diameter percutaneous applicators. The applicators have a 3-cm active tip and create a freeze zone of approximately 3 cm (length) by 2 cm (width). Two cryoapplicators were placed simultaneously into the mass in a parallel fashion with the tips approximately...

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“…Cryoablation can be used effectively for local tumor control and pain palliation, and in patients with metastatic soft tissue and bone tumors (25). A single ablation session is effective in most patients, and is well tolerated, because cryoablation causes mild or insignificant pain compared with other ablation techniques, and provides long-lasting pain relief (Fig.…”

Section: Soft Tissue and Bone Tumorsmentioning

confidence: 99%

Percutaneous cryoablation: techniques and clinical applications

Tatlı¹,

Açar²,

Silverman³

2008

Diagn Interv Radiol

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Painful Metastases Involving Bone: Percutaneous Image-guided Cryoablation—Prospective Trial Interim Analysis

Abstract: Percutaneous cryoablation is a safe and effective method for palliation of pain due to metastatic disease involving bone.

Cited by 213 publications

References 23 publications

Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Solitary Fibrous Tumor of the Buccal Space: Treatment with Percutaneous Cryoablation

Percutaneous cryoablation: techniques and clinical applications

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