Download PDF
Semin Musculoskelet Radiol 2011; 15(2): 125-134
DOI: 10.1055/s-0031-1275595
© Thieme Medical Publishers

Fire and Ice: Percutaneous Ablative Therapies and Cement Injection in Management of Metastatic Disease of the Spine

Peter L. Munk1 , 2 , Kieran J. Murphy3 , Afshin Gangi4 , David M. Liu1 , 2 , 5
  • 1Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  • 2University of British Columbia, Vancouver, British Columbia, Canada
  • 3Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario Canada
  • 4Department of Non-Vascular Interventional Radiology, University Hospital, University of Strasbourg, Strasbourg, France
  • 5Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
Further Information

Publication History

Publication Date:
15 April 2011 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Oncology intervention is actively moving beyond simple bone cement injection. Archimedes taught us that a volume displaces its volume. Where does the tumor we displace with our cement injection go? It is no longer acceptable that we displace tumor into the venous system with our cement injections. We must kill the tumor first. Different image-guided percutaneous techniques can be used for treatment in patients with primary or secondary bone tumors. Curative ablation can be applied for the treatment of specific benign or in selected cases of malignant localized spinal tumors. Pain palliation therapy of primary and secondary bone tumors can be achieved with safe, fast, effective, and tolerable percutaneous methods. Ablation (chemical, thermal, mechanical), cavitation (radiofrequency ionization), and consolidation (cementoplasty) techniques can be used separately or in combination. Each technique has its indications, with both advantages and drawbacks. To prevent pathological fractures, a consolidation is necessary. In spinal or acetabular tumors, a percutaneous cementoplasty should be associated with cryoablation to avoid a compression fracture. The cement is injected after complete thawing of the ice ball or the day after the cryotherapy. A syndrome of multiorgan failure, severe coagulopathy, and disseminated intravascular coagulation following hepatic cryoablation has been described and is referred to as the cryoshock phenomenon.

KEYWORDS

Vertebroplasty - radiofrequency ablation - cryoablation - metastases - myeloma

REFERENCES

  • 1 Husband D J. Malignant spinal cord compression: prospective study of delays in referral and treatment.  BMJ. 1998;  317 (7150) 18-21
    CrossrefPubMedGoogle Scholar
  • 2 Dorrepaal K L, Aaronson N K, van Dam F S. Pain experience and pain management among hospitalized cancer patients. A clinical study.  Cancer. 1989;  63 (3) 593-598
    CrossrefPubMedGoogle Scholar
  • 3 Callstrom M R, Charboneau J W, Goetz M P et al.. Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation.  Radiology. 2002;  224 (1) 87-97
    CrossrefPubMedGoogle Scholar
  • 4 Buy X, Basile A, Bierry G, Cupelli J, Gangi A. Saline-infused bipolar radiofrequency ablation of high-risk spinal and paraspinal neoplasms.  AJR Am J Roentgenol. 2006;  186 (5, Suppl) S322-S326
    CrossrefPubMedGoogle Scholar
  • 5 Grönemeyer D HW, Schirp S, Gevargez A. Image-guided radiofrequency ablation of spinal tumors: preliminary experience with an expandable array electrode.  Cancer J. 2002;  8 (1) 33-39
    CrossrefPubMedGoogle Scholar
  • 6 Goetz M P, Callstrom M R, Charboneau J W et al.. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study.  J Clin Oncol. 2004;  22 (2) 300-306
    CrossrefPubMedGoogle Scholar
  • 7 Horrow M M, Stassi J, Shurman A, Brody J D, Kirby C L, Rosenberg H K. The limitations of carotid sonography: interpretive and technology-related errors.  AJR Am J Roentgenol. 2000;  174 (1) 189-194
    PubMedGoogle Scholar
  • 8 Thanos L, Mylona S, Galani P et al.. Radiofrequency ablation of osseous metastases for the palliation of pain.  Skeletal Radiol. 2008;  37 (3) 189-194
    CrossrefPubMedGoogle Scholar
  • 9 Toyota N, Naito A, Kakizawa H et al.. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience.  Cardiovasc Intervent Radiol. 2005;  28 (5) 578-583
    CrossrefPubMedGoogle Scholar
  • 10 Nakatsuka A, Yamakado K, Maeda M et al.. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies.  J Vasc Interv Radiol. 2004;  15 (7) 707-712
    CrossrefPubMedGoogle Scholar
  • 11 van der Linden E, Kroft L JM, Dijkstra P DS. Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients.  J Vasc Interv Radiol. 2007;  18 (6) 741-747
    CrossrefPubMedGoogle Scholar
  • 12 Halpin R J, Bendok B R, Sato K T, Liu J C, Patel J D, Rosen S T. Combination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report.  Surg Neurol. 2005;  63 (5) 469-474 discussion 474-475
    CrossrefPubMedGoogle Scholar
  • 13 Schaefer O, Lohrmann C, Herling M, Uhrmeister P, Langer M. Combined radiofrequency thermal ablation and percutaneous cementoplasty treatment of a pathologic fracture.  J Vasc Interv Radiol. 2002;  13 (10) 1047-1050
    CrossrefPubMedGoogle Scholar
  • 14 Hoffmann R T, Jakobs T F, Trumm C, Weber C, Helmberger T K, Reiser M F. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease.  J Vasc Interv Radiol. 2008;  19 (3) 419-425
    CrossrefPubMedGoogle Scholar
  • 15 Heran M K, Legiehn G M, Munk P L. Current concepts and techniques in percutaneous vertebroplasty.  Orthop Clin North Am. 2006;  37 (3) 409-434 vii
    CrossrefPubMedGoogle Scholar
  • 16 Munk P L, Rashid F, Heran M K et al.. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone.  J Vasc Interv Radiol. 2009;  20 (7) 903-911
    CrossrefPubMedGoogle Scholar
  • 17 Woolf C J, Allchorne A, Safieh-Garabedian B, Poole S. Cytokines, nerve growth factor and inflammatory hyperalgesia: the contribution of tumour necrosis factor alpha.  Br J Pharmacol. 1997;  121 (3) 417-424
    CrossrefPubMedGoogle Scholar
  • 18 Simon C J, Dupuy D E, Mayo-Smith W W. Microwave ablation: principles and applications.  Radiographics. 2005;  25 (Suppl 1) S69-S83
    CrossrefPubMedGoogle Scholar
  • 19 Hoffmann N E, Bischof J C. The cryobiology of cryosurgical injury.  Urology. 2002;  60 (2, Suppl 1) 40-49
    CrossrefPubMedGoogle Scholar
  • 20 Theodorescu D. Cancer cryotherapy: evolution and biology.  Rev Urol. 2004;  6 (Suppl 4) S9-S19
    PubMedGoogle Scholar
  • 21 Baust J G, Gage A A. The molecular basis of cryosurgery.  BJU Int. 2005;  95 (9) 1187-1191
    CrossrefPubMedGoogle Scholar
  • 22 Gangi A, Tsoumakidou G, Buy X, Quoix E. Quality improvement guidelines for bone tumour management.  Cardiovasc Intervent Radiol. 2010;  33 (4) 706-713
    CrossrefPubMedGoogle Scholar
  • 23 Gangi A, Alizadeh H, Wong L, Buy X, Dietemann J L, Roy C. Osteoid osteoma: percutaneous laser ablation and follow-up in 114 patients.  Radiology. 2007;  242 (1) 293-301
    CrossrefPubMedGoogle Scholar
  • 24 Dupuy D E, Hong R, Oliver B, Goldberg S N. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal.  AJR Am J Roentgenol. 2000;  175 (5) 1263-1266
    CrossrefPubMedGoogle Scholar
  • 25 Dupuy D E, Goldberg S N. Image-guided radiofrequency tumor ablation: challenges and opportunities—part II.  J Vasc Interv Radiol. 2001;  12 (10) 1135-1148
    CrossrefPubMedGoogle Scholar
  • 26 Thanos L, Mylona S, Galani P et al.. Radiofrequency ablation of osseous metastases for the palliation of pain.  Skeletal Radiol. 2008;  37 (3) 189-194
    CrossrefPubMedGoogle Scholar
  • 27 Buy X, Tok C H, Szwarc D, Bierry G, Gangi A. Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring.  Cardiovasc Intervent Radiol. 2009;  32 (3) 529-534
    CrossrefPubMedGoogle Scholar
  • 28 Allaf M E, Varkarakis I M, Bhayani S B, Inagaki T, Kavoussi L R, Solomon S B. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation—initial observations.  Radiology. 2005;  237 (1) 366-370
    CrossrefPubMedGoogle Scholar
  • 29 Beland M D, Dupuy D E, Mayo-Smith W W. Percutaneous cryoablation of symptomatic extraabdominal metastatic disease: preliminary results.  AJR Am J Roentgenol. 2005;  184 (3) 926-930
    PubMedGoogle Scholar
  • 30 Callstrom M R, Atwell T D, Charboneau J W et al.. Painful metastases involving bone: percutaneous image-guided cryoablation—prospective trial interim analysis.  Radiology. 2006;  241 (2) 572-580
    CrossrefPubMedGoogle Scholar
  • 31 Baust J G, Gage A A. Progress toward optimization of cryosurgery.  Technol Cancer Res Treat. 2004;  3 (2) 95-101
    PubMedGoogle Scholar
  • 32 Clarke D M, Robilotto A T, Rhee E et al.. Cryoablation of renal cancer: variables involved in freezing-induced cell death.  Technol Cancer Res Treat. 2007;  6 (2) 69-79
    PubMedGoogle Scholar
  • 33 Gage A A, Baust J. Mechanisms of tissue injury in cryosurgery.  Cryobiology. 1998;  37 (3) 171-186
    CrossrefPubMedGoogle Scholar
  • 34 Kam A W, Littrup P J, Walther M M, Hvizda J, Wood B J. Thermal protection during percutaneous thermal ablation of renal cell carcinoma.  J Vasc Interv Radiol. 2004;  15 (7) 753-758
    CrossrefPubMedGoogle Scholar
  • 35 Korpan N. Basics of Cryosurgery. New York, NY: Springer-Verlag; 2001
    CrossrefGoogle Scholar
  • 36 Bickels J, Kollender Y, Merimsky O, Isaakov J, Petyan-Brand R, Meller I. Closed argon-based cryoablation of bone tumours.  J Bone Joint Surg Br. 2004;  86 (5) 714-718
    CrossrefPubMedGoogle Scholar
  • 37 Lane M D, Le H B, Lee S et al.. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients.  Skeletal Radiol. 2011;  40 (1) 25-32
    CrossrefPubMedGoogle Scholar
  • 38 Bageacu S, Kaczmarek D, Lacroix M, Dubois J, Forest J, Porcheron J. Cryosurgery for resectable and unresectable hepatic metastases from colorectal cancer.  Eur J Surg Oncol. 2007;  33 (5) 590-596
    CrossrefPubMedGoogle Scholar
  • 39 Seifert J K, France M P, Zhao J et al.. Large volume hepatic freezing: association with significant release of the cytokines interleukin-6 and tumor necrosis factor a in a rat model.  World J Surg. 2002;  26 (11) 1333-1341
    CrossrefPubMedGoogle Scholar
  • 40 Seifert J K, Morris D L. World survey on the complications of hepatic and prostate cryotherapy.  World J Surg. 1999;  23 (2) 109-113 discussion 113-114
    CrossrefPubMedGoogle Scholar

Peter L MunkM.D. 

Department of Radiology, Vancouver General Hospital

855 West 12th Ave., Vancouver, BC V5Z 1M9 Canada

Email: peter.munk@vch.ca

      >