Deib Gerard, Deldar Benyamin, Hui Ferdinand, Barr Jennifer S, Khan Majid A
Department of Radiology, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287.
St George's University of London, London, UK.
AJR Am J Roentgenol. 2019 Jun;212(6):1377-1384. doi: 10.2214/AJR.18.20386. Epub 2019 Mar 27.
The purpose of this study was to review the efficacy and durability of pain control and local tumor control using microwave ablation and cementoplasty in treating extraspinal osseous tumors. Painful osseous metastases are a common cause of cancer-related morbidity. Percutaneous thermal ablation presents an attractive minimally invasive option in this vulnerable patient group. A retrospective review included 65 patients (35 men, 30 women) with 77 tumors who underwent image-guided microwave ablation and cementoplasty at a tertiary referral academic center over 18 months. Procedural efficacy was determined with a visual analog scale before the procedure and 24 hours, 2-4 weeks, and 20-24 weeks after the procedure. Locoregional control was assessed at follow-up cross-sectional imaging. The 77 tumors were in the following locations: ilium, 38; acetabulum on supraacetabular region, 23; femur, five; humerus, four; shoulder, four; sternum, three. The tumors were 15 multiple myelomas and metastases from cancers of the following organs: colon, nine; lung, 15; breast, 12; thyroid, seven; prostate, three; and kidney, four. Complete, successful ablation of all 77 tumors was achieved. Mean ablation time was 6 minutes 15 seconds (SD, 12 seconds), and mean energy used was 5.49 (SD, 2.97) kJ. The mean visual analog scale scores were 6.32 (SD, 1.94) before the procedure, 1.01 (SD, 1.24) at 24 hours, 1.71 (SD, 1.31) at 2-4 weeks, and 2.01 (SD, 1.42) at 20-24 weeks. Follow-up imaging at 20-24 weeks showed no local progression in 42 of 65 patients (64.6%). Six patients died 24-52 weeks after the procedure. No procedure-related complications were reported. Microwave ablation is efficacious in alleviating pain due to osseous metastases. The modality has promise for locoregional control of metastases, particularly in the context of oligometastatic (limited disseminated) disease.
本研究的目的是回顾使用微波消融和骨水泥成形术治疗脊柱外骨肿瘤时疼痛控制和局部肿瘤控制的疗效及持久性。疼痛性骨转移是癌症相关发病的常见原因。经皮热消融对于这类脆弱的患者群体而言是一种有吸引力的微创选择。一项回顾性研究纳入了65例患者（35例男性，30例女性），共77个肿瘤，这些患者在一家三级转诊学术中心于18个月内接受了影像引导下的微波消融和骨水泥成形术。在术前、术后24小时、2 - 4周以及20 - 24周，使用视觉模拟量表来确定手术疗效。通过随访横断面成像评估局部控制情况。77个肿瘤分布于以下部位：髂骨38个；髋臼及髋臼上区域23个；股骨5个；肱骨4个；肩部4个；胸骨3个。这些肿瘤包括15个多发性骨髓瘤以及来自以下器官癌症的转移瘤：结肠9个；肺15个；乳腺12个；甲状腺7个；前列腺3个；肾脏4个。所有77个肿瘤均实现了完全、成功的消融。平均消融时间为6分15秒（标准差12秒），平均能量使用为5.49（标准差2.97）kJ。术前视觉模拟量表平均评分为6.32（标准差1.94），术后24小时为1.01（标准差1.24），2 - 4周为1.71（标准差1.31），20 - 24周为2.01（标准差1.42）。20 - 24周的随访成像显示，65例患者中有42例（64.6%）无局部进展。6例患者在术后24 - 52周死亡。未报告与手术相关的并发症。微波消融在缓解骨转移引起的疼痛方面是有效的。这种方法有望实现转移瘤的局部控制，尤其是在寡转移（有限播散）疾病的情况下。
