Department of Neuro-Oncology, H Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida 33612, USA.
Curr Opin Support Palliat Care. 2011 Sep;5(3):222-6. doi: 10.1097/SPC.0b013e328349652d.
To review the current status of vertebral augmentation procedures (VAPs) in the management of symptomatic vertebral compression fractures (VCFs) in cancer patients.
The natural history of VCFs in the cancer setting is presumably different from the one seen with osteoporotic fractures. Factors contributing to the poor outcome with conservative treatment in cancer patients include continued bone loss due to tumor invasion, poor nutritional status, immobilization, prolonged steroid use, gonadal ablation, chemotherapy and radiotherapy. VAPs have been shown by retrospective and prospective randomized studies to be effective in treating symptomatic VCFs. Advantages of VAPs include immediate pain relief, avoiding delays in chemoradiation, outpatient care in the majority of cases, biopsy, vertebral height restoration, and potential antitumor effect of bone cement. Results from the prospective randomized Cancer Fracture Evaluation (CAFÉ) trial show superiority of balloon kyphoplasty (BKP) over conservative management in cancer patients with VCFs with similar rate of adverse events between treatment arms. Additionally, the field is still evolving with advances such as combination with radiosurgery and spinal radiofrequency ablation (RFA), use of kyphoplasty without a balloon and highly viscous cement to prevent leakage.
VAPs are well tolerated and effective methods to provide palliative care for cancer patients with VCFs and should be offered to symptomatic patients.
回顾椎体强化术（VAP）在癌症患者椎体压缩性骨折（VCF）治疗中的应用现状。
癌症患者 VCF 的自然病程与骨质疏松性骨折不同。导致保守治疗效果不佳的因素包括肿瘤侵袭导致持续骨丢失、营养状况差、固定、长期使用类固醇、性腺切除、化疗和放疗。回顾性和前瞻性随机研究表明，VAP 对治疗症状性 VCF 有效。VAP 的优点包括即刻缓解疼痛、避免因放化疗而延迟治疗、大多数情况下可门诊治疗、活检、椎体高度恢复，以及骨水泥的潜在抗肿瘤作用。前瞻性随机癌症骨折评估（CAFÉ）试验的结果表明，与保守治疗相比，球囊扩张椎体后凸成形术（BKP）在 VCF 癌症患者中具有优势，且治疗组之间不良事件的发生率相似。此外，该领域仍在不断发展，例如与放射外科和脊柱射频消融（RFA）相结合、无球囊使用后凸成形术以及使用高粘度骨水泥以防止渗漏。
VAP 是为 VCF 癌症患者提供姑息治疗的一种耐受良好且有效的方法，应向有症状的患者提供。
