Pusceddu Claudio, De Francesco Davide, Melis Luca, Ballicu Nicola, Fancellu Alessandro
Regional Referral Center for Oncologic Disease, Department of Oncological and Interventional Radiology, Businco Hospital, A.O. Brotzu, 09100 Cagliari, Italy.
Institute for Global Health, UCL, Royal Free Campus Rowland Hill Street, London NW3 2PF, UK.
Curr Oncol. 2021 Oct 8;28(5):4004-4015. doi: 10.3390/curroncol28050340.
The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control.
Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control.
The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9-6.5) before tRFA and to 0.9 (95% CI 0.4-1.3) after tRFA ( < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2-5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1-2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4-46 months) and 10 months (4-37 months), respectively.
Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.
本研究旨在评估一种导航射频消融装置联合椎体强化术治疗椎体后部转移性病变的有效性，此类病变在技术上难以处理。本研究的主要结果是评估疼痛缓解情况以及对局部肿瘤控制的影像学评估。
35例患者共41处累及椎体后部的脊柱转移瘤接受了计算机断层扫描引导下的经皮靶向射频消融术，使用导航射频消融装置，并联合椎体强化术。21例患者（60%）有1处或2处转移瘤（A组），14例患者（40%）有多处（>2处）椎体转移瘤（B组）。采用视觉模拟量表（VAS）评估疼痛严重程度的变化。通过影像学评估转移瘤的局部控制情况。
所有治疗的椎体在技术上均获成功。在有症状的患者中，VAS评分均值从射频消融术前的5.7（95%可信区间4.9 - 6.5）降至术后的0.9（95%可信区间0.4 - 1.3）（P < 0.001）。基线至随访1周时VAS评分的平均降低值为4.8（95%可信区间4.2 - 5.4）。射频消融术后1周与1年之间VAS评分随时间的降低情况相似，表明疼痛缓解迅速且持久。在分别为期19个月（4 - 46个月）和10个月（4 - 37个月）的中位随访期内，1 - 2处椎体转移瘤患者和多处转移瘤患者在靶椎均未出现肿瘤局部进展或复发的影像学征象。
使用导航射频消融装置联合椎体强化术治疗脊柱转移瘤可实现局部肿瘤控制，迅速且持久地缓解疼痛，为难治性脊柱转移瘤的多模式管理提供了有效的治疗方法。
