Abstract
Bone metastasis in the spine are lesions that are very challenging to manage because of pain, possible respiratory and neurological complications due to the closeness with the spinal cord. In fact, a fracture of a vertebra weakened by a pathological tissue can occur. In this paper, an experience of a single center in treating bone metastasis in the vertebral soma is reported (both fractured than with an increased risk of fracture) with a combined procedure of ablation, vertebroplasty and radiotherapy. This combined strategy aims to obtain an increased ability to treat the pathological tissue (ablation and radiotherapy) and a stabilization of the osteolytic lesion (vertebroplasty). We evaluated the outcome of this procedure in 12 lesions (in 11 patients) with a follow-up (from 6 to 48 months) with clinical and imaging data. Patients showed an immediate, rapid and persistent regression of the symptomatology in all lesions except two. Moreover, a stability of the disease in the bone segment treatment was reached. Even if this is a pilot study for the number of patients and the follow-up, we believe that this approach could be promising as these early results are. In specific clinical conditions and selected patients, this study seems to be possible to perform a curative approach.
Similar content being viewed by others
References
Zhao W, Wang H, Hu JH, Peng ZH, Chen JZ, Huang JQ, et al. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Jpn J Clin Oncol. 2018;48(8):753–9.
Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, et al. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol. 2011;21(9):2004–100.
Lo SS, Sahgal A, Hartsell WF, Lutz ST, Kardamakis D, van der Linden Y, et al. The treatment of bone metastasis with highly conformal radiation therapy: a brave new world or a costly mistake? Clin Oncol. 2009;21(9):662–4.
Huang M, Zhu H, Liu T, Cui D, Huang Y. Comparison of external radiotherapy and percutaneous vertebroplasty for spinal metastasis. Asia Pac J Clin Oncol. 2016;12(2):e201–e208208.
Barile A, Bruno F, Arrigoni F, Splendiani A, Di Cesare E, Zappia M, et al. Emergency and trauma of the ankle. Semin Musculoskelet Radiol. 2017;21:3.
Barile A, Bruno F, Mariani S, Arrigoni F, Reginelli A, De Filippo M, et al. What can be seen after rotator cuff repair: a brief review of diagnostic imaging findings. Musculoskelet Surg. 2017;101:3–14.
Barile A, Conti L, Lanni G, Calvisi V, Masciocchi C. Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy. Eur J Radiol. 2013;82(4):633–9.
Ripani M, Continenza MA, Cacchio A, Barile A, Parisi A, De Paulis F. The ischiatic region: Normal and MRI anatomy. J Sports Med Phys Fitness. 2006;46(3):468–75.
Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C. Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness. 2008;48(4):483–7.
Mariani S, La Marra A, Arrigoni F, Necozione S, Splendiani A, Di Cesare E, et al. Dynamic measurement of patello-femoral joint alignment using weight-bearing magnetic resonance imaging (WB-MRI). Eur J Radiol. 2015;84(12):2571–8.
Zappia M, Castagna A, Barile A, Chianca V, Brunese L, Pouliart N. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder. Skeletal Radiol. 2017;46(8):1101–11.
Di Pietto F, Chianca V, de Ritis R, Cesarano E, Reginelli A, Barile A, et al. Postoperative imaging in arthroscopic hip surgery. Musculoskeletal Surg. 2017;101:43–9.
Barile A, Arrigoni F, Bruno F, Palumbo P, Floridi C, Cazzato RL, et al. Present role and future perspectives of interventional radiology in the treatment of painful bone lesions. Futur Oncol. 2018;14(28):2945–55.
Cazzato RL, Arrigoni F, Boatta E, Bruno F, Chiang JB, et al. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med. 2018;1(0123456789):3. https://doi.org/10.1007/s11547-018-0938-8.
Giordano AV, Arrigoni F, Bruno F, Carducci S, Varrassi M, Zugaro L, et al. Interventional radiology management of a ruptured lumbar artery pseudoaneurysm after cryoablation and vertebroplasty of a lumbar metastasis. Cardiovasc Intervent Radiol. 2017;40(5):776–9.
Arrigoni F, Bruno F, Zugaro L, Natella R, Cappabianca S, Russo U, et al. Developments in the management of bone metastases with interventional radiology. Acta Biomed. 2018;89:166–74.
Gangi A, Ph D, Buy X. Percutaneous bone tumor. Management. 2010;1(212):124–36.
Ringe KI, Panzica M, Radiology I. Thermoablation of bone tumors thermoablation von Knochentumoren. RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 2016;188:539–50.
Cazzato RL, Garnon J, Caudrelier J, Prabhakar P, Koch G, Gangi A, et al. Percutaneous radiofrequency ablation of painful spinal metastasis : a systematic literature assessment of analgesia and safety literature assessment of analgesia and safety. Int J Hyperth. 2018;34(8):1272–81.
Carrafiello G, Lagana D, Mangini M, Fontana F, Dionigi G, Boni L, Rovera F, et al. Microwave tumors ablation : Principles, clinical applications and review of preliminary experiences. Int J Surg. 2008;6:65–9.
Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24(2):229–33.
Masciocchi C, Conchiglia A, Gregori LM, Arrigoni F, Zugaro L, Barile A. Critical role of HIFU in musculoskeletal interventions. Radiol Medica. 2014;119(7):470–5.
Masciocchi C, Arrigoni F, La MA, Mariani S, Zugaro L, Barile A. Treatment of focal benign lesions of the bone: MRgFUS and RFA. Br J Radiol. 2016;89:20150356.
Arrigoni F, Barile A, Zugaro L, Splendiani A, Di Cesare E, Caranci F, et al. Intra-articular benign bone lesions treated with Magnetic Resonance-guided Focused Ultrasound (MRgFUS): imaging follow-up and clinical results. Med Oncol. 2017;34(4):55.
Masciocchi C, Arrigoni F, Ferrari F, Giordano AV, Iafrate S, Capretti I, et al. Uterine fibroid therapy using interventional radiology mini-invasive treatments: current perspective. Med Oncol. 2017;34(4):52.
Arrigoni F, Gregori LM, Zugaro L, Barile A, Masciocchi C. MRgFUS in the treatment of MSK lesions: A review based on the experience of the university of L’aquila. Italy. Translational Cancer Research. 2014;3(5):442–8.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what should you use and why? RadioGraphics. 2014;34(5):1344–62.
Rose PS, Morris JM, Rose PS. Cryosurgery/cryoablation in musculoskeletal neoplasms : history and state of the art. Curr Rev Musculoskelet Med. 2015;8:353–60.
Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, et al. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 2016;33(12):140.
Cazzato RL, Auloge P, De MP, Rousseau C, Chiang JB, Koch G, et al. Percutaneous image-guided ablation of bone metastases : local tumor control in oligometastatic patients. Int J Hyperth. 2018;35(1):485–91.
Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, et al. Can radiotherapy be combined with radiofrequency ablation in the management of symptomatic osteolytic skeletal metastasis? Clin Oncol. 2011;23(1):65–6.
Di SM, Gravina GL, Zugaro L, Bonfili P, Gregori L, Franzese P, et al. Treatment of solitary painful osseous metastases with radiotherapy, cryoablation or combined therapy: Propensity matching analysis in 175 patients. PLoS ONE. 2015;10(6):1–11.
Cazzato RL, Buy X, Grasso RF, Luppi G, Faiella E, Quattrocchi CC, et al. Interventional Radiologist’s perspective on the management of bone metastatic disease. Eur J Surg Oncol. 2015;41(8):967–74.
Roberto CL, Francesco A, Emanuele Boatta FB, Chiang B, Garnon J, Zugaro L, Victor A, et al. Percutaneous management of bone metastases : state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med. 2018;124(1):34–49.
Kam NM, Maingard J, Kok HK, Ranatunga D, Brooks D, Torreggiani WC, et al. Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update. Curr Treat Options Oncol. 2017;18(12):74.
Maugeri R, Graziano F, Basile L, Gulì C, Giugno A, Giammalva GR, et al. Reconstruction of vertebral body after radiofrequency ablation and augmentation in dorsolumbar metastatic vertebral fracture: analysis of clinical and radiological outcome in a clinical series of 18 patients. Trends in Reconstr Neurosurg. 2017;124:81–6.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours : Revised RECIST guideline (version 1.1). Eur J Cancer. 2008;45(2):228–47.
Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, et al. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol. 2017;34(4):53.
Mcmenomy BP, Kurup AN, Johnson GB, Carter RE, Mcwilliams RR, Markovic SN, et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol. 2013;24(2):207–13.
Monahan KC, Steinberg L, Mulvey EP. NIH public access. Hum Dev. 2010;45(6):1654–68.
Deschamps F, Farouil G, Ternes N, Gaudin A. Thermal ablation techniques : a curative treatment of bone metastases in selected patients? Eur Radiol. 2014;24(8):1971–80.
Filippiadis AKD, Brountzos GAE. Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture : the rebar concept. Cardiovasc Intervent Radiol. 2015;39(1):90–6.
Weichselbaum RR, Hellman S. Oligometastases revisited. Nat Publ Gr. 2011;8(6):378–82.
Acknowledgements
Authors wish to thank Angela Martella for translating the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Arrigoni, F., de Cataldo, C., Bruno, F. et al. Ablation, consolidation and radiotherapy for the management of metastatic lesions of the spine: impact on the quality of life in a mid-term clinical and diagnostic follow-up in a pilot study. Med Oncol 37, 53 (2020). https://doi.org/10.1007/s12032-020-01378-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12032-020-01378-6