Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

Chang Su Kim; Young Ho Kwon; So Hak Chung; Samuel Baek

doi:10.4184/jkss.2016.23.4.207

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Kim, Kwon, Chung, and Baek: Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

Original Article

Journal of Korean Spine Surg 2016;23(4):207-215.

Published online: 31 December 2016

DOI: https://doi.org/10.4184/jkss.2016.23.4.207

Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

Chang Su Kim, M.D., Young Ho Kwon, M.D., So Hak Chung, M.D., Samuel Baek, M.D.

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea

Corresponding author: Chang Su Kim, M.D. Department of Orthopedic Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea TEL: +82-51-990-6467, FAX: +82-51-243-0181 E-mail: mewha98@naver.com

Received 25 May 20161 June 2016 Accepted 12 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To evaluate the clinical efficacy and safety of radiofrequency (RF) ablation therapy followed by a bone cement augmentation procedure in treating and managing pain among metastatic spine tumor patients.

Summary of Literature Review

As a metastatic spine tumor is unresectable, this procedure was performed. Results showed an increase in the necrosis rate, and a decrease in local recurrence and secondary vertebral stability.

Materials and Methods

From March 2007 to April 2016, 26 patients who were treated with RF ablation with a bone cement augmentation procedure and the same number of patients treated with radiotherapy for metastatic spine lesions were included in this study. Pain relief and functional quality of life were evaluated using a visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ).

Results

VAS scores preoperatively and at 1, 4, and 12 weeks follow-up were 7.45, 3.01, 3.78, and 2.97 in the procedure group, and 7.04, 6.65, 5.87, and 3.03 in the radiotherapy group. The procedure group had significantly better average outcomes than the radiotherapy group for pain relief at 4 weeks but showed no difference at 12 weeks. The RMQ score improved from 13.92 to 7.21 in the procedure group, and from 15.33 to 9.75 in the radiotherapy group. Two patients who had a metastatic tumor near the vertebral body posterior cortex showed cement leakage into the disc space, that is, intraforaminal and intracanal space; therefore, operations were performed (7.69% nerve injury).

Conclusions

RF ablation therapy with cement augmentation in treatment of metastatic spine tumor shows effectiveness in early pain relief and brings immediate vertebral stability, helping patients return to normal life. However, it carries a risk of nerve injury due to cement leakage.

Keywords: Radiofrequency ablation, Cement augmentation, Spinal metastases, Pain relief, Cement leakage

REFERENCES

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Fig. 1.

Postoperative anteroposterior (A) and lateral (B) radiographs of a 66-year-old female treated with radiofrequency ablation with vertebroplasty for uterine cancer spine bone metastasis at T6, L5, and S1. Her last follow-up anteroposterior (C) and lateral (D) radiographs 8 years later show some bone subsidence.

Fig. 2.

Preoperative (A, B) and postoperative (C, D) anteroposterior (A) and lateral (B, C, D) radiographs of a 34-year-old male treated with radiofre-quency ablation with vertebroplasty for mesenchymal chondrosarcoma spine bone metastasis at L2, L3, S2, and S3 with an osteoclastic lesion. Leakage of bone cement into the intracanal and intraforaminal space (C) irritated the L2 and L3 nerves and induced back pain, so an L2/L3 partial laminectomy for decompression (D) was performed 28 days later.

Fig. 3.

Preoperative (A, B) and postoperative (C, D) anteroposterior (A) and lateral (B, C, D) radiographs of a 72-year-old female treated by radiofre-quency ablation with vertebroplasty for urothelial cell carcinoma spine bone metastasis at T12, L2, L3, and L5 with an osteoblastic lesion. Leakage of bone cement into the intracanal and intraforaminal space (C, D) was noted, so T12/L1 partial laminectomy for decompression was performed just after the procedure.

Table 1.

Demographic chart of the RF^∗ ablation with cement augmentation group

No	Age/Sex	Tumor origin	Cell type	Spine Meta Location	Frequency of operation	Expire
1	57/M	Breast	Ductal ca.	L1, L2, L3, T7	2	0
2	55/M	Breast	Ductal ca.	T9, T10, T11	1	0
3	28/M	OSA^\|\|	Osteoblastic	L3, L5	1	0
4	57/M	Esophageal	Small cell ca.	T3, T10, T11, S1	1	0
5	71/M	Lung	NSCLC^† (adeno ca.)	T9, L3	2	0
6	54/M	Rectal	Adeno ca.	L4, L5	1
7	57/M	Lung	NSCLC (adeno ca.)	L5	1	0
8	47/M	Liver	HCC	T5	1	0
9	67/M	Lung	NSCLC (adeno ca.)	L1, L2, L4	1	0
10	66/F	Uterine	Squamous cell ca.	T12, L5, S1	1
11	78/M	Prostate		L3	1
12	77/F	Thyroid	Papillary ca.	T11, L1	1
13	55/M	Liver	HCC^‡	T12	1
14	58/F	Lung	SCLC^§ (atypical)	C3, T1, T4, T10, T11, L2, L3, L4, L5	1
15	57/M	Pancreatic	Adeno ca.	C5, T10, L4, L5	1
16	62/M	Rectal	Adeno ca.	L2	1
17	52/F	Stomach	Adeno ca.	T7	1	0
18	68/M	Renal	Adeno ca.	L1, L2, S1	1	0
19	52/M	Rectal	Adeno ca.	L4	1
20	67/M	Rectal	Adeno ca.	T6, L3	1
21	57/M	Rectal	Adeno ca.	T10, L1	1
22	63/M	Lung	NSCLC (adeno ca.)	L3	1	0
23	34/M	Chondrosarcoma	Mesenchymal	L2, L3, S2, S3	1	0
24	57/F	Thyroid	Papillary ca.	T3, T10, L3	1
25	73/M	Renal	Adeno ca.	S2	1	0
26	72/F	Urothelial cell carcino	oma Squamous ca.	T12, L2, L3, L5	1

^∗ RF: radiofrequency

^† NSCLC: non small cell lung cancer

^‡ HCC: hepatocellular carcinoma

^§ SCLC: small cell lung cancer

^|| OSA: osteosarcoma.

Table 2.

Demographic chart of the radiotherapy group

No	Age/Sex	Tumor origin	Cell type	Spine Meta Location	Frequency of RTx.	Expire
1	60/M	Liver	HCC^†	T10, T11, T12	10	0
2	65/F	Myeloma	Multiple myeloma	C5, C6, C7	10
3	57/M	Lung	NSCLC^∗ (SQLC)	T9, L3	20	0
4	53/F	Breast	Ductal ca.	T9, L1, L5	30
5	62/F	Breast	Ductal ca.	L2, L3, L4	10
6	71/F	Rectum	Adeno ca.	L2	10
7	52/F	Breast	Ductal ca.	L2, T1	20
8	71/F	Lung	NSCLC (adeno ca.)	L4, S1	10	0
9	59/M	Lung	NSCLC (adeno ca.)	L3, L4, L5	30
10	83/F	Lung	NSCLC	T12, L1, L2	10
11	52/F	Lung	NSCLC (adeno ca.)	L3, L5	20	0
12	36/M	Pancrease	Adeno ca.	L2	10	0
13	57/M	Lung	NSCLC (adeno ca.)	T3, T6, T10, T12, L3, L4, L5	20
14	47/M	Lung	NSCLC (adeno ca.)	T11, T12, L1, L4	30
15	57/M	Stomach	Adeno ca.	T9	10
16	60/M	Renal	RCC (papillary type)	T1, T2, T3, T4, T7, T8, T9, T12, L2, L3	10	0
17	55/M	Lung	SCLC^‡	T9, T11, L1	10	0
18	33/F	OSA	Fibroblastic	L1, L2	10
19	47/M	Rectal	Adeno ca.	L5	10	0
20	25/M	Renal	RCC^§ (papillary type)	T12, L4	20	0
21	74/M	Thyroid	Papillary ca.	T4, T5, T6	10
22	53/F	Breast	Ductal ca.	L3, S3	30	0
23	59/M	liver	Ductal ca.	L2, L3, S2, S3	20	0
24	62/F	Breast	Ductal ca.	T4, T11, T12	10
25	73/F	Breast	Ductal ca.	S1, S2, S3	10	0
26	64/M	Lung	NSCLC (adeno ca.)	T12, L3, L5	20

^∗ NSCLC: non small cell lung cancer

^† HCC: hepatocellular carcinoma

^‡ SCLC: small cell lung cancer

^§ RCC: renal cell carcinoma.

Table 3.

Pain Relief compared with both groups by VAS score

	VAS
	Pre-OP	POD 1 week		POD 4 weeks	POD 12 weeks	p-value^§	p for interaction^§
Group A^†	7.45		3.01	3.78	2.97	<0.001	0.004
Group B^‡	7.04		6.65	5.87	3.03	<0.001	0.004

^∗ VAS: visual analog scale

^† Group A: radiofrequency ablation with vertebroplasty

^‡ Group B: radiotherapy

^§ p-values by repeated measure t-test.

Table 4.

Comparison of both groups by RMQ score

	RMQ
	Pre-OP	POD 12 weeks	p-value^§	p for interaction^§
Group A^†	13.92	7.21	<0.001	0.024
Group B^‡	15.33	9.75	<0.001	0.024

^∗ RMQ: roland moris questionnaire

^† Group A: radiofrequency ablation with vertebroplasty

^‡ Group B: radiotherapy

^§ p-values by repeated measure t-test.

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