title: Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions.
abstract: BACKGROUND
  Treatment of spinal metastatic lesions by radiofrequency ablation (RFA) before cementation can potentially help in local tumor control and pain relief. This is often limited by access and tumor location. This study reports multicenter clinical and imaging outcomes following targeted RFA (t-RFA) and cement augmentation in neoplastic lesions of the spine.
  
  
  METHODS
  A retrospective multicenter study of 49 patients with 72 painful vertebral lesions, evaluated for clinical and imaging outcomes following RFA and cement augmentation of spinal metastatic lesions, was undertaken. Visual Analogue Pain score (VAS) and Oswestry Disability Index (ODI) were obtained before and 2-4 weeks after treatment. Pre- and post-procedure imaging examinations including MRI and positron emission tomography (PET) were also evaluated.
  
  
  RESULTS
  Mean ablation time was 3.7±2.5 min (range 0.92-15). Mean VAS scores decreased from 7.9±2.5 pre-procedure to 3.5±2.6 post-procedure (p<0.0001). Mean ODI scores improved from 34.9±18.3 to 21.6±13.8 post-procedure (p<0.0001). Post-contrast MRI resulted in a predictable pattern of decreased tumor volume and an enhancing rim. Metabolically active lesions in pre-procedure PET scans (n=10 levels) showed decreased fluorodeoxyglucose activity after ablation.
  
  
  CONCLUSIONS
  t-RFA followed by vertebral augmentation in malignant vertebral lesions resulted in significant pain reduction and functional status improvement, with no major complications. t-RFA permitted access to vertebral lesions and real-time accurate monitoring of the ablation zone temperature. Post-procedure MRI and PET examinations correlated with a favorable tumor response and helped to monitor tumor growth and the timing of adjuvant therapy.
authors.affiliation: Point Loma Nazarene University, San Diego, California, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Reyes
authors.affiliation: Department of Family practice and Public Health, University of California, San Diego, La Jolla, California, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Georgy
authors.affiliation: Department of Psychology, Boston University, Boston University, Boston, Massachusetts, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Brook
authors.affiliation: Department of Radiology, Winthrop-University Hospital, Clinical Professor of Radiology at the State University of New York-Stony Brook, Mineola, New York, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Ortiz
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Allan
authors.initials: A
authors.lastname: Brook
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Cardarelli Hosp Naples Italy, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Muto
authors.affiliation: Department of Neurosurgery -Minimal Invasive Spine, Institute of Oncology in Mediterranean (IOM), Viagrande, Catania, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Manfre
authors.affiliation: Chief of Radiology Unit, SS Trinità Hospital-ASL Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Marcia
authors.affiliation: San Diego Imaging, University of California, San Diego, San Diego, California, USA.
authors.forename: Bassem A
authors.initials: BA
authors.lastname: Georgy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000592:standards* / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000379:methods / Q000592:standards*; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging; D059408:Pain Management / Q000379:methods / Q000592:standards*; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*
chemical_list: D001843:Bone Cements
keywords: Malignant; Metastatic; Spine