Department of Internal Medicine, Brookdale University Medical Center, Brooklyn, NY 11212, USA.
Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Clin Neurosci. 2022 Oct;104:48-55. doi: 10.1016/j.jocn.2022.07.025. Epub 2022 Aug 11.
Osseous metastases to the spine result in significant pain and decreased quality of life. The purpose of this study was to evaluate the long-term efficacy of microwave ablation (MWA) for the treatment of spinal metastases regarding pain reduction and local control of disease progression. In this single center retrospective study, patients with osseous metastases to the spine undergoing MWA with vertebroplasty from 2013 to 2020 were included. Locoregional control of metabolic activity at the treated level was assessed using PET/CT scan both pre- and post-procedure. Pain reduction was measured using change in visual analog scale (VAS) pain score. Forty-eight spinal levels were treated with MWA in 28 patients (57 % male, mean age 68 ± 9 years). Median ablation time, energy, and temperature were 4 min and 13 s, 3.6 kJ, and 80 °C, respectively. Median pre-procedure maximum standard uptake value (SUVmax) was significantly reduced following ablation, from 4.55 (IQR 3.65-6.1) to 0 (IQR 0-1.8; p < 0.001), over an average of 29 ± 14.1 month follow up period. Pre-procedure VAS pain score was reduced from median (IQR) of 8 (6.5-9) to 1(1-2), 2(1-3) and 1(0.5-3) at 24 h, four weeks, and six months post-procedure, respectively (all p < 0.001 with respect to pre-procedure scores). In conclusion, this study supports microwave ablation as an effective technique for pain palliation and long-term locoregional tumor control of oligometastatic spinal disease as assessed by metabolic response.
脊柱骨转移导致严重疼痛和生活质量下降。本研究旨在评估微波消融（MWA）治疗脊柱转移瘤的长期疗效，包括减轻疼痛和局部控制疾病进展。在这项单中心回顾性研究中，纳入了 2013 年至 2020 年间接受 MWA 联合椎体成形术治疗的脊柱骨转移患者。在治疗前后，通过 PET/CT 扫描评估治疗水平的代谢活性局部控制情况。疼痛缓解通过视觉模拟量表（VAS）疼痛评分的变化来衡量。28 例患者的 48 个脊柱节段接受了 MWA 治疗（57%为男性，平均年龄 68±9 岁）。消融的中位消融时间、能量和温度分别为 4 分钟 13 秒、3.6kJ 和 80°C。中位治疗前最大标准摄取值（SUVmax）在消融后显著降低，从 4.55（IQR 3.65-6.1）降至 0（IQR 0-1.8；p<0.001），平均随访 29±14.1 个月。治疗前 VAS 疼痛评分从治疗前的中位数（IQR）8（6.5-9）分别降至 24 小时后 1（1-2）、4 周后 2（1-3）和 6 个月后 1（0.5-3）（与治疗前评分相比，所有 p<0.001）。综上所述，本研究支持微波消融作为一种有效的治疗方法，可通过代谢反应缓解疼痛并长期局部控制寡转移脊柱疾病。
