Cazzato Roberto L, De Marini Pierre, Leonard-Lorant Ian, Dalili Danoob, Koch Guillaume, Autrusseau Pierre A, Mayer Theo, Weiss Julia, Auloge Pierre, Garnon Julien, Gangi Afshin
Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
Diagn Interv Imaging. 2021 Jun;102(6):355-361. doi: 10.1016/j.diii.2020.12.008. Epub 2021 Jan 22.
To retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases.
From February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60±8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients' demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS).
Sixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38±19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31±21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2±2 (SD) (median, 1; range: 0-6) vs. 5±1 (median, 5; range: 4-8; P<0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4±4 (SD) (median, 2; range: 1-8) months follow-up.
Percutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.
回顾性报告经皮消融骶骨转移瘤的安全性、疼痛缓解情况及局部肿瘤控制效果。
2009年2月至2020年6月，23例连续患者（12例女性，11例男性；平均年龄60±8[标准差]岁；中位数60岁；范围：48 - 80岁）的23处骶骨转移瘤在本机构接受了射频消融（RFA）或冷冻消融（CA），目的为姑息性或根治性。收集并分析患者的人口统计学资料以及与治疗的转移瘤、手术相关变量、安全性和消融后临床进展相关的数据。采用数字疼痛评分量表（NPRS）评估疼痛。
16例（70%）患者接受姑息性治疗，7例（30%）患者接受根治性治疗。平均肿瘤直径为38±19（标准差）mm（中位数36；范围：11 - 76）。消融前对5处转移瘤（5/23；22%）进行了外照射治疗。9处转移瘤（39%）采用RFA，其余14处（61%）采用CA。治疗20处（87%）和8处（35%）转移瘤时分别采用了热保护措施和辅助骨巩固。记录到5例（22%）轻微并发症。在平均31±21（标准差）（中位数32；范围：2 - 70）个月的随访中，平均NPRS为2±2（标准差）（中位数1；范围：0 - 6），而基线时为5±1（中位数5；范围：4 - 8；P<0.001）。7例接受根治性消融的转移瘤中有3例（43%）在平均4±4（标准差）（中位数2；范围：1 - 8）个月的随访中出现局部进展。
经皮消融骶骨转移瘤是安全的，可显著持久缓解疼痛。局部肿瘤控制似乎不太理想；然而，由于数据有限，需要进一步研究来证实这些发现。
