Interventional procedure overview of radiofrequency ablation for palliation of painful spinal metastases

Retrospective analysis

Turkey (single centre)

2015-2020

N=66 patients with painful spinal metastases.

RFA alone (n=26) compared with RFA +vertebroplasty (n=40)

Sites: thoracic in 22, lumbar in 18; multiple metastasis in 20

Mean age 59.5 years, range 52 to 69 years); 100% female

Inclusion criteria: patients above 18 years, with osteolytic vertebral metastasis, spinal involvement and neurologically stable, primary tumour under control, with analgesic-resistant pain, and with more than 3 months of life expectancy were included.

Exclusion criteria: Patients with active primary tumours, neurologically unstable and previously received radiotherapy for the spine, and those in need of surgical decompression and instrumentation were excluded.

Imaging was done in all patients before the procedure. Percutaneous RFA was administered to the vertebrae infiltrated by the neoplastic lesions, under local anaesthesia and conscious sedation at an average temperature of 90°C for 2 to 4 min.

In the RFA group, decompression surgery was performed in 10 patients with 50% collapse of the vertebral corpus or fragments in the spinal canal during 6 months.

40 patients with vertebral metastases underwent vertebroplasty with polymethylmethacrylate radio-opaque bone cement injection after RFA.

6 months

None

Prospective pilot study

Germany

Not reported

N=16 patients with painful spinal metastases of breast cancer.

Site: vertebral body of the lumbar and thoracic spine

Average tumour size: 1.9 cm (range 1.2 to 3.5 cm)

8 treated with RFA alone and 8 treated with RFA plus bone cement.

mean age 59.5 years, range 52 to 69 years); 100% female

Inclusion criteria: pain (refractory to previous treatment) and imminent fracture or instability of the bone due to rapid tumour growth, absence of neurological deficits and an increase of the pain during movement or excessive stress.

Exclusion criteria: any vertebral fractures, radicular neurological symptoms, coagulation disturbances, rheumatic diseases, allergy to local anaesthesia, pregnancy and any infections (e.g. spondylitis, spondylodiscitis).

Percutaneous RFA of bone tumour with Celon pro surge and Celon power system.

This is an outpatient procedure done with CT guidance and under local anaesthesia. A bipolar and impedance-controlled radiofrequency system was used. After RFA, bone cement was injected into the necrosis cavity in half of the patients (n=8).

Mean 20.4 months (range 836).

Not reported

RFA group (n=8)

Mean 7.6 (range 6- 10 points)

5.5 (range 3-8 points; p=0.018)

4.0 (range 2-6 points; p<0.008)

49.4%

RFA + cement (n=8)

Mean 7.9 (7-10 points)

5.0 (range 3-7 points; p=0.005)

3.5 (range 1-5; p<0.005)

53.9%

Prospective case series

Japan

2005-2007

n=10 patients with painful spinal tumours

Lesions were located mainly in lumbar or thoracic area. Metastases origin from breast, lung, and renal cancers. previous treatments (n=4) chemotherapy, radiation therapy, surgery, or a combination.

Tumour size: mean 4.9 cm (range 3-8 cm); The distance between tumour and spinal cord mean, 2.4 mm (1-4mm).

location of tumour: thoracic (3), lumbar (6), sacral (1). All invaded the posterior cortex of the vertebral body or pedicle and were facing spinal canal.

Mean age 61 years; 60% male.

Inclusion criteria: a painful spinal tumour refractory to previous medical treatment with radiation therapy and/or chemotherapy and a distance of 1 cm or less between the spinal tumour invaded the posterior cortex of the vertebral body or pedicle and spinal cord.

Exclusion criteria a Zubrod performance status of 4, the presence of symptomatic spinal cord compression, or a platelet count of less than 50,000/lL or an international normalized ratio greater than 1.5.

Patients were treated with monopolar RFA and had cement augmentation. RFA was done under conscious sedation and local anaesthesia. Cool-tip RFA ablation system was used.

The thermocouple was placed in the spinal canal (epidural space in 6, subarachnoid space in 4) under CT fluoroscopic guidance. On average RFA was applied for 8 minutes. Monitoring of the spinal canal temperature was done during the procedure. Temperature in tumour was mean 77 degrees. When the spinal canal temperature reached 45 degree C, RFA was immediately stopped (in 9). In 1 patient it suddenly rose to 48 degree C. When a tumour was located in the vertebral body and greater than 3 cm, bone cement was injected immediately after RFA to minimize the risk of future fracture in 6 patients.

Mean 4.5 months (range 2.7 to 7.1 months)

Not reported.

RFA (all patients)

7.5

2.7 (1 week)

4.8 (0.00005)

64

RFA alone (n=4)

4.3

1.7 (1 week)

2.6 (0.0004)

60

RFA + cement augmentation (n=6)

6.6

1.7 (1 week)

4.9 (0.003)

74

Prospective cohort study

Germany (single centre)

2006-2009

n=36 patients with advanced tumours with primary or secondary tumour involvement of spine and near neurological structures.

location of tumour: lumbar 22, thoracic 16, sacral 2, cervical 1

Mean age 67.8 years (range 40 to 84 years); 60% male.

Inclusion criteria: patients with disease progression despite previous surgery, maximal chemotherapy, maximal radiation and hormone therapy, lack of highly invasive surgical option, severe local tumour pain, insufficiently responsive to opiates and other analgesics, intervertebral tumour spread, risk of paraplegia or fracture because of tumour progression, locomotor disability because of a local tumour process, and osteolytic and mixed metastases with palliative intention.

Exclusion criteria: presence of intradural and intramedullary tumours, risk of bleeding (acetylsalicylic acid, anticoagulants), acute general infections, local infections in the target zone, and allergies against one of the periinterventional applied drugs.

Patients were treated with bipolar RFA (39 lesions) under general anaesthesia by 3 neuroradiologists. CelonLab Power and Celon Aquaflow III ablation systems were used. RFA power was limited to 50 watts. Average power was 27.28 watts (range 9.51 to 36.58 watts). Average energy needed was 33.46 kJ (varied from 9.95 to 85 kJ).

Not reported

None