What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis

Navanith Murali, Thomas Turmezei, Sumbal Bhatti, Puja Patel, Thomas Marshall, Toby Smith, Navanith Murali, Thomas Turmezei, Sumbal Bhatti, Puja Patel, Thomas Marshall, Toby Smith

Abstract

Purpose: Spinal metastases are indicative of progressive cancer which can lead to vertebral body fractures and spinal cord compression. Radiofrequency ablation (RFA) treatment is infrequently used in patients with refractory pain. The aim of this systematic review is to determine the clinical efficacy of RFA, with the scope of using it as front-line management of spinal metastases.

Methods: Electronic databases were searched (to July 2020) for studies evaluating RFA treatment for spinal metastases in adults. Measured outcomes were pain (primary), disability, health-related quality of life (HRQOL), complications, tumour control and mortality. Study inclusion, data extraction and risk of bias using the ROBIN-I tool were assessed. Meta-analysis was conducted for pooled results with homogeneity, and narrative synthesis was conducted otherwise.

Results: 15 studies were included. RFA reduces pain scores at 3-5 weeks [standardised mean difference (SMD 2.24, 95% confidence intervals (CI) 1.55-2.93], 3-4 months (SMD 3.00, 95% CI 1.11-4.90) and 5-6 months (SMD 3.54, 95% CI 1.96-5.11). RFA is effective in reducing disability/improving HRQOL in the short-term but longer-term efficacy remains unclear. 13.2% cases reported local tumour control failure (2.5 months-5 year follow-up) whereas mortality was 23.6% (follow-up of up to 1 year).

Conclusion: Low quality evidence has proven RFA to be safe and effective in reducing pain and disability, especially in the short-term. RFA may be routinely implemented in all cases involving refractory pain or radiotherapy-resistant tumours but controlled trials are required to compare the efficacy of RFA to current frontline treatments. PROSPERO protocol registration number: CRD42020202377.

Keywords: Back pain; Radiofrequency ablation; Radiotherapy; Spinal cord compression; Spinal metastases.

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
PRISMA flow diagram depicting literature search and study inclusion

References

    1. Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA. Physiopathology of spine metastasis. Int J Surg Oncol. 2011;2011:107969. doi: 10.1155/2011/107969.
    1. Ziu E, Viswanathan VK, Mesfin FB. Spinal metastasis. StatPearls [Internet]. StatPearls Publishing; 2020.
    1. Robson P. Metastatic spinal cord compression: a rare but important complication of cancer. Clin Med (Lond) 2014 doi: 10.7861/clinmedicine.14-5-542.
    1. De Vita VT, Hellman S, Rosenberg SA. Principles and practice of oncology. 11. Williams and Wilkins: Lippincott; 2019.
    1. Mossa-Basha M, Gerszten PC, Myrehaug S, Mayr NA, Yuh WT, Jabehdar Maralani P, Sahgal A, Lo SS. Spinal metastasis: diagnosis, management and follow-up. Br J Radiol. 2019;92(1103):20190211. doi: 10.1259/bjr.20190211.
    1. National Institute for Health and Care Excellence. Metastatic spinal cord compression in adults: risk assessment, diagnosis and management | Guidance. 2021. . Accessed 23 Feb 2021.
    1. Navaneethan U, Thosani N, Goodman A, Manfredi M, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S, Maple JT. Radiofrequency ablation devices. VideoGIE. 2017;2(10):252–259. doi: 10.1016/j.vgie.2017.06.002.
    1. McCall T, Cole C, Dailey A. Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events. Curr Rev Musculoskelet Med. 2008;1(1):17–23. doi: 10.1007/s12178-007-9013-0.
    1. Jennings JW. Clinical utility of targeted radiofrequency ablation in spinal metastatic disease. Oncol Times. 2018;40(15):13–15. doi: 10.1097/01.COT.0000544333.45592.6d.
    1. Rosian K, Hawlik K, Piso B. Efficacy assessment of radiofrequency ablation as a palliative pain treatment in patients with painful metastatic spinal lesions: a systematic review. Pain Physician. 2018;21(5):E467–E476. doi: 10.36076/ppj.2018.5.E467.
    1. Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety. Int J Hyperthermia. 2018;34(8):1272–1281. doi: 10.1080/02656736.2018.1425918.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed1000097.
    1. Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014;21(14):579. doi: 10.1186/s12913-014-0579-0.
    1. Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JPT. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ. 2016;35:i4919. doi: 10.1136/bmj.i4919.
    1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions version 6.2. 2021. .
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;21(339):b2700. doi: 10.1136/bmj.b2700.
    1. Bagla S, Sayed D, Smirniotopoulos J, Brower J, Neal Rutledge J, Dick B, Carlisle J, Lekht I, Georgy B. Multicenter prospective clinical series evaluating radiofrequency ablation in the treatment of painful spine metastases. Cardiovasc Intervent Radiol. 2016;39(9):1289–1297. doi: 10.1007/s00270-016-1400-8.
    1. Sayed D, Jacobs D, Sowder T, Haines D, Orr W. Spinal radiofrequency ablation combined with cement augmentation for painful spinal vertebral metastasis: a single-center prospective study. Pain Physician. 2019;22(5):E441–E449. doi: 10.36076/ppj/2019.22.E441.
    1. Prezzano KM, Prasad D, Hermann GM, Belal AN, Alberico RA. Radiofrequency ablation and radiation therapy improve local control in spinal metastases compared to radiofrequency ablation alone. Am J Hosp Palliat Care. 2019;36(5):417–422. doi: 10.1177/1049909118819460.
    1. Tomasian A, Hillen TJ, Chang RO, Jennings JW. Simultaneous bipedicular radiofrequency ablation combined with vertebral augmentation for local tumor control of spinal metastases. AJNR Am J Neuroradiol. 2018;39(9):1768–1773. doi: 10.3174/ajnr.A5752.
    1. Zhao W, Wang H, Hu JH, Peng ZH, Chen JZ, Huang JQ, Jiang YN, Luo G, Yi GF, Shen J, Gao BL. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Jpn J Clin Oncol. 2018;48(8):753–759. doi: 10.1093/jjco/hyy090.
    1. Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies. Int J Hyperthermia. 2018;34(8):1282–1288. doi: 10.1080/02656736.2017.1422557.
    1. Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. Combined ablation and radiation therapy of spinal metastases: a novel multimodality treatment approach. Pain Physician. 2015;18(6):573–581. doi: 10.36076/ppj.2015/18/573.
    1. Anchala PR, Irving WD, Hillen TJ, Friedman MV, Georgy BA, Coldwell DM, Tran ND, Vrionis FD, Brook A, Jennings JW. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician. 2014;17(4):317–327.
    1. Gevargez A, Groenemeyer DH. Image-guided radiofrequency ablation (RFA) of spinal tumors. Eur J Radiol. 2008;65(2):246–252. doi: 10.1016/j.ejrad.2007.03.026.
    1. Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol. 2015;124(1):111–118. doi: 10.1007/s11060-015-1813-2.
    1. Zheng L, Chen Z, Sun M, Zeng H, Zuo D, Hua Y, Cai Z. A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment. Med Sci Monit. 2014;4(20):556–563. doi: 10.12659/MSM.889742.
    1. Proschek D, Kurth A, Proschek P, Vogl TJ, Mack MG. Prospective pilot-study of combined bipolar radiofrequency ablation and application of bone cement in bone metastases. Anticancer Res. 2009;29(7):2787–2792.
    1. Dabravolski D, Lahm A, Eßer J. Merk H (2015) Tumoren und Metastasen an der Wirbelsäule : Cavity/Coblation-Operation und Vertebro-/Kyphoplastie [Tumours and metastases of the spine : cavity/coblation surgery and vertebroplasty/kyphoplasty] Orthopade. 2015;44(10):806–819. doi: 10.1007/s00132-015-3138-4.
    1. Georgy BA. Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions. AJNR Am J Neuroradiol. 2009;30(6):1197–1202. doi: 10.3174/ajnr.A1548.
    1. Nakatsuka A, Yamakado K, Takaki H, Uraki J, Makita M, Oshima F, Takeda K. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Intervent Radiol. 2009;32(1):70–75. doi: 10.1007/s00270-008-9390-9.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅