Advertisement

CardioVascular and Interventional Radiology

, Volume 37, Issue 1, pp 203–210 | Cite as

Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

  • Gianluigi Orgera
  • Miltiadis Krokidis
  • Marco Matteoli
  • Gianluca Maria Varano
  • Giacinto La Verde
  • Vincenzo David
  • Michele Rossi
Clinical Investigation

Abstract

Purpose

This study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).

Methods

Thirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.

Results

Technical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.

Conclusions

The use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

Keywords

Skeletal interventions Radiofrequency ablation Vertebroplasty Multiple Myeloma Pain Vertebral compression fracture (VCF) 

Notes

Conflict of interest

All authors have no conflict of interest

References

  1. 1.
    Lecouvet FE, Vande Berg BC, Maldague BE et al (1997) Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology 204:195–199PubMedGoogle Scholar
  2. 2.
    Kyle RA, Gertz MA, Witzig TE et al (2003) Review of 1,027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 78:21–33PubMedCrossRefGoogle Scholar
  3. 3.
    Croucher PI, Apperley JF (1998) Bone disease in myeloma. Br J Haematol 103:902–910PubMedCrossRefGoogle Scholar
  4. 4.
    Deramond H, Depriester C, Galibert P et al (1998) Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36:533–546PubMedCrossRefGoogle Scholar
  5. 5.
    Chen LH, Hsieh MK, Niu CC et al (2012) Percutaneous vertebroplasty for pathological vertebral compression fractures secondary to multiple myeloma. Arch Orthop Trauma Surg 132:759–764PubMedCrossRefGoogle Scholar
  6. 6.
    Chew C, Ritchie M, O’Dwyer PJ et al (2011) A prospective study of percutaneous vertebroplasty in patients with myeloma and spinal metastases. Clin Rad 66:1193–1196CrossRefGoogle Scholar
  7. 7.
    Trumm C, Jakobs T, Pahl A et al (2012) CT fluoroscopy-guided percutaneous vertebroplasty in patients with multiple myeloma: analysis of technical results from 44 sessions with 67 vertebrae treated. Diagn Interv Radiol 18:111–120PubMedGoogle Scholar
  8. 8.
    Groenemeyer DH, Schirp S, Gevargez A (2002) Image guided radiofrequency ablation of spinal tumours: preliminary experience with an expandable array electrode. Cancer J 8:33–39CrossRefGoogle Scholar
  9. 9.
    Lane M, Huy B, Lee S et al (2011) Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol 40:25–32PubMedCrossRefGoogle Scholar
  10. 10.
    International Myeloma Working Group (2003) Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 121:749–757CrossRefGoogle Scholar
  11. 11.
    McGraw JK, Cardella J, Barr JD et al (2003) Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 14:311–315CrossRefGoogle Scholar
  12. 12.
    Roland MO, Morris RW (1983) A study of the natural history of back pain. Part 1: development of a reliable and sensitive measure of disability in low back pain. Spine 8:141–144PubMedCrossRefGoogle Scholar
  13. 13.
    Evans AJ, Jensen ME, Kip KE et al (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226(2):366–372PubMedCrossRefGoogle Scholar
  14. 14.
    Barragan-Campos HM, Vallee JN, Lo D et al (2006) Percutaneous vertebroplasty for spinal metastases: complications. Radiology 238(1):354–362PubMedCrossRefGoogle Scholar
  15. 15.
    Wardlaw D, Cummings SR, Van Meirhaeghe J et al (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture: a randomised controlled trial. Lancet 373:1016–1024PubMedCrossRefGoogle Scholar
  16. 16.
    Kallmes DF, Comstock BA, Gray LA et al (2009) Baseline pain and disability in the investigational vertebroplasty efficacy and safety trial. AJNR Am J Neuroradiol 30:1203–1205PubMedCrossRefGoogle Scholar
  17. 17.
    Barr JD, Barr MS, Lemley TJ et al (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923–928PubMedCrossRefGoogle Scholar
  18. 18.
    Toyota N, Naito A, Kakizawa H et al (2005) Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Interv Radiol 28:578–583CrossRefGoogle Scholar
  19. 19.
    Munk PL, Rashid F, Heran MK et al (2009) Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 7:903–911CrossRefGoogle Scholar
  20. 20.
    Callstrom MR, Charboneau JW, Goetz MP et al (2002) Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radiofrequency ablation. Radiology 224:87–97PubMedCrossRefGoogle Scholar
  21. 21.
    Woolf CJ, Allchorne A, Safieh-Garabedian B et al (1997) Cytokines, nerve growth factor and inflammatory hyperalgesia: the contribution of tumour necrosis factor alpha. Br J Pharmacol 121:412–417CrossRefGoogle Scholar
  22. 22.
    Halpin RJ, Bendok BR, Sat KT et al (2005) Combination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report. Surg Neurol 63:469–475PubMedCrossRefGoogle Scholar
  23. 23.
    Georgy BA (2009) Bone cement deposition patterns with plasma-mediated radiofrequency ablation and cement augmentation for advanced metastatic spine lesions. AJNR Am J Neuroradiol 30:1197–1202PubMedCrossRefGoogle Scholar
  24. 24.
    Kaufmann TJ, Trout AT, Kallmes DF (2006) The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 27:1933–1937PubMedGoogle Scholar
  25. 25.
    Cotten A, Dewatre F, Cortet B et al (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow up. Radiology 200:525–530PubMedGoogle Scholar
  26. 26.
    San Millan Ruiz D, Burkhardt K, Jean B et al (1999) Pathology findings with acrylic implants. Bone 25:85–90CrossRefGoogle Scholar
  27. 27.
    Schaefer O, Lohrmann C, Herling M et al (2002) Combined radiofrequency thermal ablation and percutaneous cementoplasty treatment of a pathological fracture. J Vasc Interv Radiol 13:1047–1050PubMedCrossRefGoogle Scholar
  28. 28.
    Kallmes DF, Comstock MS, Heagerty PJ et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. New Engl J Med 361:569–579PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Klazen CA, Lohle PN, de Vries J et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092PubMedCrossRefGoogle Scholar
  30. 30.
    Anselmetti GC, Marcia S, Saba L et al (2012) Percutaneous vertebroplasty: multi-centric results from EVEREST experience in large cohort of patients. Eur J Radiol 81:4083–4086PubMedCrossRefGoogle Scholar
  31. 31.
    Sandri A, Carbognin G, Regis D et al (2010) Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies. 115:261–271Google Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Gianluigi Orgera
    • 1
  • Miltiadis Krokidis
    • 2
  • Marco Matteoli
    • 1
  • Gianluca Maria Varano
    • 1
  • Giacinto La Verde
    • 3
  • Vincenzo David
    • 1
  • Michele Rossi
    • 1
  1. 1.Department of Radiology, S. Andrea HospitalSapienza Rome UniversityRomeItaly
  2. 2.Department of RadiologyCambridge University Hospitals NHS TrustCambridgeUK
  3. 3.Department of Medical Oncology, S. Andrea HospitalSapienza Rome UniversityRomeItaly

Personalised recommendations