Fallahi Mohammad Sadegh, Maroufi S Farzad, Parmis Maroufi S, Khorasanizadeh MirHojjat, de Macêdo Filho Leonardo José Monteiro, Margetis Konstantinos, Guha Daipayan, Tatsui Claudio E, Mansouri Alireza
Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
J Neurooncol. 2025 May 13. doi: 10.1007/s11060-025-05064-3.
Minimally invasive techniques such as vertebroplasty, kyphoplasty, radiofrequency ablation, and stereotactic body radiotherapy have been widely used to manage spinal metastases. Among these, percutaneous cryoablation (PCA) has emerged as a promising option for local tumor control and pain management, offering targeted treatment with minimal damage to surrounding tissues. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCA for spinal metastases.
A systematic review was conducted using PubMed and Embase databases to identify studies that reported outcomes of PCA for spinal metastases. The reported radiologic, clinical, and complication outcomes were then combined and analyzed using meta-analytic methods including the calculation of pooled means and proportions, subgroup analysis, and meta-regression.
Eleven studies, including 229 patients, met inclusion criteria and were analyzed. Patients had a mean age of 61.8 years, with 60.6% being female. Breast (18.6%), lung (16.0%), and thyroid (8.0%) were the most common primary cancer sites. PCA was primarily conducted under general anesthesia (47.5%) and with CT/MRI guidance (93.9%). Local tumor control was achieved in 70.5% of cases over a mean follow-up of 12.6 months. Pain severity significantly decreased postoperatively, with a mean reduction of 4.5 points (P < 0.0001). Major and minor complication rates were 2.0% and 4.8%, respectively.
PCA is an effective alternative treatment for spinal metastases, offering pain relief and local tumor control with low complication rates in appropriately selected patients. However, tumor location and patient age may influence treatment outcomes, underscoring the need for individualized treatment planning.
椎体成形术、后凸成形术、射频消融术和立体定向体部放疗等微创技术已广泛应用于脊柱转移瘤的治疗。其中，经皮冷冻消融术（PCA）已成为局部肿瘤控制和疼痛管理的一种有前景的选择，可在对周围组织损伤最小的情况下进行靶向治疗。本系统评价和荟萃分析旨在评估PCA治疗脊柱转移瘤的疗效和安全性。
通过PubMed和Embase数据库进行系统评价，以识别报告PCA治疗脊柱转移瘤结果的研究。然后使用荟萃分析方法，包括计算合并均值和比例、亚组分析和荟萃回归，对报告的放射学、临床和并发症结果进行合并和分析。
11项研究，共229例患者，符合纳入标准并进行了分析。患者的平均年龄为61.8岁，女性占60.6%。乳腺癌（18.6%）、肺癌（16.0%）和甲状腺癌（8.0%）是最常见的原发癌部位。PCA主要在全身麻醉下进行（47.5%），并在CT/MRI引导下进行（93.9%）。在平均12.6个月的随访中，70.5%的病例实现了局部肿瘤控制。术后疼痛严重程度显著降低，平均降低4.5分（P < 0.0001）。主要和次要并发症发生率分别为2.0%和4.8%。
PCA是脊柱转移瘤的一种有效替代治疗方法，在适当选择的患者中可缓解疼痛并控制局部肿瘤，并发症发生率低。然而，肿瘤位置和患者年龄可能会影响治疗结果，这突出了个体化治疗计划的必要性。
