Cindrič Helena, Kos Bor, Tedesco Giuseppe, Cadossi Matteo, Gasbarrini Alessandro, Miklavčič Damijan
1 Laboratory of Biocybernetics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia.
2 Department of Oncologic and Degenerative Spine Surgery, Rizzoli Orthopedic Institute, Bologna, Italy.
Technol Cancer Res Treat. 2018 Jan 1;17:1533034618770253. doi: 10.1177/1533034618770253.
Vertebral column is the most frequent site for bone metastases. It has been demonstrated in previous studies that bone metastases can be efficiently treated by electrochemotherapy. We developed a novel approach to treat spinal metastases, that is, transpedicular approach that combines electrochemotherapy with already established technologies for insertion of fixation screws in spinal surgery. In the transpedicular approach, needle electrodes are inserted into the vertebral body through pedicles and placed around the tumor. The main goal of our study was to numerically investigate the feasibility of the proposed treatment approach. Three clinical cases were used in this study-1 with a tumor completely contained within the vertebral body and 2 with tumors spread also to the pedicles and spinal canal. Anatomically accurate numerical models were built for all 3 cases, and numerical computations of electric field distribution in tumor and surrounding tissue were performed to determine the treatment outcome. Complete coverage of tumor volume with sufficiently high electric field is a prerequisite for successful electrochemotherapy. Close to 100% tumor coverage was obtained in all 3 cases studied. Two cases exhibited tumor coverage of >99%, while the coverage in the third case was 98.88%. Tumor tissue that remained untreated was positioned on the margin of the tumor volume. We also evaluated hypothetical damage to spinal cord and nerves. Only 1 case, which featured a tumor grown into the spinal canal, exhibited potential risk of neural damage. Our study shows that the proposed transpedicular approach to treat spinal metastases is feasible and safe if the majority of tumor volume is contained within the vertebral body. In cases where the spinal cord and nerves are contained within the margin of the tumor volume, a successful and safe treatment is still possible, but special attention needs to be given to evaluation of potential neural damage.
脊柱是骨转移最常见的部位。先前的研究已经表明，电化学疗法可以有效治疗骨转移。我们开发了一种治疗脊柱转移瘤的新方法，即经椎弓根入路，该方法将电化学疗法与脊柱手术中已有的固定螺钉植入技术相结合。在经椎弓根入路中，针电极通过椎弓根插入椎体并放置在肿瘤周围。我们研究的主要目的是从数值上研究所提出的治疗方法的可行性。本研究使用了3个临床病例——1例肿瘤完全局限于椎体内，2例肿瘤还扩散至椎弓根和椎管。为所有3个病例建立了解剖学精确的数值模型，并对肿瘤及周围组织中的电场分布进行了数值计算，以确定治疗效果。用足够高的电场完全覆盖肿瘤体积是成功进行电化学疗法的前提条件。在所研究的所有3个病例中，肿瘤覆盖率均接近100%。2例的肿瘤覆盖率>99%，而第3例的覆盖率为98.88%。未得到治疗的肿瘤组织位于肿瘤体积的边缘。我们还评估了对脊髓和神经的潜在损伤。只有1例肿瘤长入椎管的病例显示出有神经损伤的潜在风险。我们的研究表明，如果大部分肿瘤体积局限于椎体内，所提出的经椎弓根治疗脊柱转移瘤的方法是可行且安全的。在脊髓和神经位于肿瘤体积边缘内的情况下，仍然有可能成功且安全地进行治疗，但需要特别注意评估潜在的神经损伤。
