Exploring the Efficacy of Combining Radiofrequency Thermal Ablation or Microwave Ablation with Vertebroplasty for Pain Control and Disease Management in Metastatic Bone Disease—A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Data Extraction
3. Results
3.1. RFA and VP
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- Pain Assessment: pain assessment was primarily conducted using the Visual Analog Scale (VAS), with some studies employing other measures such as the Numeric Rating Scale (NRS), Brief Pain Inventory, and other specific scales.
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- Pain Outcomes: across the studies, there is a consistent trend of significant pain reduction following the procedures. For instance, in studies using VAS, the pain scores typically decreased from high levels (e.g., 7–9) before the procedure, to lower levels (e.g., 1–3) within weeks to months post procedure. This suggests a substantial immediate and sustained benefit in pain relief.
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- Tumor Control: tumor control was not consistently reported across all studies, making a direct comparison challenging. However, some studies reported specific outcomes. Tomasian et al., indeed, reported a local tumor control rate of 78.9% [14]. Wallace et al. found local tumor control rates of 89% at the 3-months follow-up, decreasing to 70% at 1 year post treatment [15].
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- Progression-Free Survival: Yang et al. [16] noted that 66.67% of patients did not show tumor progression, with a mean progression-free survival of approximately 330 days.
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- Functional Outcomes and Quality of Life: some studies utilized functional measures like the Oswestry Disability Index (ODI) and the Karnofsky Performance Scale (KPS) to assess the impact on patients’ daily activities and overall well-being. These studies reported significant improvements post procedure; studies that included quality-of-life assessments, such as those using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, showed notable improvements post intervention (e.g., Zhang et al. [17]), indicating that pain relief is often accompanied by enhanced functional status and quality of life.
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- Complication and Safety: most studies reported low complication rates. For example, Tomasian et al. noted a total complication rate of 3.0%, with major complications at 0.4%. This suggests that the procedures are generally safe, with minimal risk of severe adverse effects [14].
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- Specific Risks: some of these studies identified specific risk factors related to procedures. Wang et al. highlighted risk factors for pulmonary cement embolism, such as multiple segment involvement, thoracic vertebrae location, and the unipedicular puncture approach [18].
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- Overall Analysis: the consistent reduction in pain scores and improvements in functional and quality-of-life measures across multiple studies indicate that the combination of RFA and VP provides substantial benefit to patients.
3.2. MWA and VP
3.3. MWA vs. RFA
Authors | Year | Study Design | Number of Patients | Mean Age | Pain Score and Other Scores Used | Tumor Control | Best Results |
---|---|---|---|---|---|---|---|
Orgera et al. [27] | 2014 | Prospective | 36 | 66 | VAS and RMQ | n/s | VAS Score (Mean): |
Before procedure: 9.1 | |||||||
After 24 h: 3.4 | |||||||
After 6 weeks: 2.0 | |||||||
RMQ Score (Mean): | |||||||
Before procedure: 19.8 | |||||||
After 24 h: 9.6 | |||||||
After 6 weeks: 8.2 | |||||||
Alfonso et al. [26] | 2023 | Retrospective | 14 | 67 | VAS | n/s | VAS score (mean): |
Before procedure: 7.7 | |||||||
After 6 weeks: 2.6 | |||||||
Senol et al. [28] | 2022 | Retrospective | 41 | 67 | VAS and ODI | n/s | VAS score (mean): |
Before procedure: 7.4 | |||||||
After 1 week and 1 months: 2.5 | |||||||
After 6 months: 3.2 | |||||||
ODI score (mean): | |||||||
Before procedure: 71.08 | |||||||
Postoperative 30.1 | |||||||
Tian et al. [29] | 2022 | Retrospective | 126 | 54 | VAS, ODI and KPS | n/s | VAS score (mean): |
Before procedure: 7.43 | |||||||
After 24 h: 2.25 | |||||||
VAS, ODI and KPS showed significant improvement after treatment (p < 0.05). | |||||||
Wallace et al. [30] | 2015 | Retrospective | 72 | 68 | NRS | n/s | NRS score (mean): |
Before procedure: 8 | |||||||
After 1 week: 3.25 | |||||||
After 4 week: 2.75 | |||||||
Yang et al. [16] | 2017 | Retrospective | 25 | 57 | KPS, ODI, VAS | A total of 66.67% patients did not present tumor progression. The mean progression-free survival: 330 ± 54 days. | VAS values were significantly reduced after surgery. |
Tomasian et al. [14] | 2021 | Retrospective | 166 | n/s | Brief Pain Inventory scores | local tumor control rate: 78.9% | total complication rate: 3.0%; |
major complication rate: 0.4%; | |||||||
minor complication rate: 2.6% | |||||||
Cazzato et al. [12] | 2018 | Retrospective | 11 | 61 | VAS and Wilcoxon test | n/s | Mean pain score: |
baseline: 7.8 ± 1.1; | |||||||
last clinical follow-up available (mean 1.9 ± 1.4 months): 3.5 ± 2 | |||||||
Wang et al. [31] | 2022 | Retrospective | 15 | 62 | VAS | n/s | VAS scores in the group that used the combination of RFA and VP decreased more rapidly one week after the treatments and remained more stable at six months compared to the group that underwent VP alone. |
Wang et al. [18] | 2023 | Retrospective | 47 | 60 | VAS | n/s | Risk analysis showed that multiple segments (≥3, p = 0.022), thoracic vertebrae (p = 0.0008), and unipedicular puncture approach (p = 0.0059) are risk factors for pulmonary cement embolism. |
Yildizhan et al. [32] | 2021 | Retrospective | 40 | n/s | VAS and ODI | No patients developed spine fractures or cord compression from tumor spread during the follow-up. | VAS Score (mean): Before procedure: 7.44 ± 1.06 in group RFA + VP; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). Pre-treatment ODI (mean): 78.50% in the RFA + VP group, which improved to 14.2% after treatment. |
Zhang et al. [17] | 2020 | Retrospective | 15 | 50 | VAS, Frankel grade, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire | n/s | Pre-op VAS (mean): 7.86 ± 0.86 |
Post-op (3 months) mean VAS: 3.51 ± 1.32 | |||||||
Frankel grade: improved 1–2 grades in 14/15 patients | |||||||
EORTC QLQ-C30 score: pre-op 86.13 ± 8.51, post-op 52.21 ± 13.28 | |||||||
Sayed et al. [33] | 2019 | Prospective | 30 | >18 | NRS and Functional Assessment of Cancer Therapy-General 7 (FACT-G7) | n/s | Average NRS-11 scores decreased from a baseline of 5.77 to 4.65 (3 days), 3.33 (one week), 2.64 (one month), and 2.61 (3 months). |
FACT-G7 increased from a baseline average of 13.0 to 14.7 (3 days), 14.69 (one week), 14.04 (one month), and 15.11 (3 months). | |||||||
Tomasian et al. [34] | 2018 | Retrospective | 27 | 55 | n/a | Local tumor control was achieved in 96% of tumors, according to median imaging follow-up of 16 weeks. | Simultaneous bipedicular RFA combined with VP is safe and effective for local tumor control of vertebral metastases. |
Pusceddu et al. [35] | 2021 | Retrospective | 35 | 59 | VAS | No tumor recurrence in index vertebrae at median follow-up of 19 months (range 4–46 months) and 10 months (range 4–37 months). | Baseline VAS score decreased significantly from 5.7 (95% CI 4.9–6.5) before tRFA to 0.9 (95% CI 0.4–1.3) after tRFA. The mean decrease in VAS score from baseline to one-week follow-up was 4.8 (95% CI 4.2–5.4). |
Giammalva et al. [36] | 2022 | Retrospective | 54 | 63 | VAS | n/a | The average baseline VAS score significantly decreased from 7.81 to 2.50 after 12 months. |
Zhao et al. [37] | 2018 | Prospective | 16 | 69 | VAS, EORTC and QLQ-C30 | n/a | Baseline VAS score: 8.1 ± 1.4, and reduced significantly to 5.5 ± 1.1 at 24 h, 2.8 ± 0.6 at 1 week, and 1.4 ± 0.8 at 6 months (p < 0.01). |
EORTC QLQ-C30 scale at 1 month showed significant improvement. | |||||||
Madani et al. [38] | 2022 | Retrospective | 18 | 54 | VAS | n/a | Baseline VAS score decreased from 7.3 ± 2.4 to 2 ± 0 (p = 0.008), along with a decrease in the mean morphine milligram-equivalent dose from 196.6 ± 135.7 to 38.5 ± 26 (p = 0.008). |
Kastler et al. [39] | 2021 | Retrospective | 25 | 60 | VAS | n/a | Post-procedure follow-up mean VAS score decreased by 74% at day 1 (6.6, p < 0.001), 79% at 1 month (6.6, p < 0.001), 79% at 3 months (6.5, p < 0.001), 77% at 6 months, and 79% at 12 months (6.6, p < 0.001). |
Wallace et al. [30] | 2016 | Retrospective | 55 | n/a | n/a | Radiographic local tumor control rates were 89% (41/46) at 3 months, 74% (26/35) at 6 months, and 70% (21/30) at 1 year post treatment. | The combined approach of RFA and VP shows effectiveness in achieving local control of spinal metastases. |
He et al. [40] | 2021 | Retrospective | 40 | n/a | VAS and spinal stenosis rates (SSRs) | n/a | VP combined with RFA shows short-term pain relief advantages, whereas VP combined with 125I particle implantation may offer superior pain relief and reduce SSRs at 3 months post operation. |
Pusceddu at al. [41] | 2023 | Retrospective | 16 | 67 | VAS and Functional Mobility Scale (FMS) | n/a | A statistically significant reduction in VAS score was observed before treatment and 1 week after treatment. The improvement in mobility before and after treatment was statistically significant. |
David et al. [42] | 2017 | Retrospective | 26 | 72 | n/a | n/a | Using RFA prior to VP significantly reduced the rate of posterior and venous cement leaks. Pain scores decreased significantly post procedure. |
Reyes et al. [43] | 2018 | Retrospective | 49 | n/a | VAS and ODI | n/a | Baseline VAS scores (mean) decreased from 7.9 ± 2.5 pre-procedure to 3.5 ± 2.6 post procedure. Mean ODI scores improved from 34.9 ± 18.3 to 21.6 ± 13.8 post procedure. |
Lu et al. [13] | 2019 | Retrospective | 169 | 57 | VAS, WHO Pain Relief and ODI | n/a | VP combined with 125I Seed exhibited the best clinical efficacy in terms of VAS score. VP combined with RT was the best in terms of WHO Pain Relief. VP combined with RFA showed the best effect in terms of ODI. |
Maugeri et al. [44] | 2017 | Retrospective | 18 | 56 | VAS | n/a | Baseline VAS score (mean): decreased significantly from 8.05 to 3.0 (p < 0.05) after 6 months. |
Clarençon et al. [45] | 2013 | Prospective | 24 | 61 | VAS | Local recurrence: 6/24 cases | Mean VAS was 1.9 (±2.4) at 1 month FU, and 2.3 (±2.9) at 6 months’ FU. Pain was significantly reduced at 6 months’ FU (mean VAS reduction = 4.1; p < 0.00001). |
Pezeshki et al. [46] | 2016 | n/a | 12 | n/a | n/a | n/a | The combination of RFA and cement placement in the posterior vertebral body shows markedly enhanced vertebral stability when subjected to axial loading. |
Van der Linden et al. [47] | 2007 | Retrospective | 12 | 57 | VAS | n/a | Baseline VAS score (mean): 17.33 ± 2.46 (range, 13–20) versus 9.25 ± 4.81 (range, 2–18) one week after treatment (p < 0.001) and 7.00 ± 5.26 (range, 1–14) three months after treatment (p = 0.020). |
Hoffmann et al. [48] | 2008 | Retrospective | 22 | 64 | VAS | n/a | Baseline VAS score (mean): 8.5, which decreased to a mean of 5.5 after 24 h (p < 0.01), and a further decrease was detected after 3 months, to 3.5 (p < 0.01). |
Song et al. [49] | 2014 | Prospective | 12 | 59 | VAS and KPS | n/a | Baseline VAS score (mean): 7.0 1.0, which decreased to 2.1 ± 1.2 at 1 month, to 1.6 ± 1.4 at 6 months, to 1.8 ± 1.7 at 1 year, and was maintained at 1.3 ± 1.1 at >1-year follow-up. KPS improving from 64.17 ± 8.20 preoperatively, to 66.58 ± 5.53 at 1 week, to 68.24 ± 3.60 at 1 month, and 68.25 ± 5.35 at 3 months, to 68.83 ± 5.86 at 6 months, to 67.13 ± 7.12 at 1 year, to 70.33 ± 8.14 at >1 year. |
Authors | Year | Study Design | Number of Patients | Pain Score and Other Scores Used | Tumor Control | Best Results |
---|---|---|---|---|---|---|
Chen et al. [50] | 2022 | Retrospective | 91 | VAS, daily morphine consumption, ODI | n/s | Baseline (mean) VAS: 6, Morphine: 77.8 mg |
Post procedure: | ||||||
3 days: VAS: 5, Morphine: 34.5 mg | ||||||
1 week: VAS: 4, Morphine: 28.7 mg | ||||||
1 month: VAS: 3, Morphine: 24.6 mg | ||||||
3 months: VAS: 3, Morphine: 21.7 mg | ||||||
6 months: VAS: 3, Morphine: 21.0 mg | ||||||
Hu et al. [51] | 2022 | Prospective | 67 | VAS, analgesic use scores (AUS), and quality-of-life score (QLS) | n/s | The VAS score was lower at 6 months (2.7 ± 0.7 vs. 3.2 ± 0.7) and 12 months (3.5 ± 0.8 vs. 4.0 ± 0.7). The AUS and QLS were improved at 12 months (p < 0.05). |
Fan et al. [20] | 2023 | Retrospective | 38 | VAS, daily morphine consumption and ODI | n/s | Baseline VAS score (mean): 6.40 ± 1.90; which decreased to 3.32 ± 0.96 at 24 h, 2.24 ± 0.91 at 1 week, 1.92 ± 1.32 at 4 weeks, 1.79 ± 1.45 at 12 weeks, and 1.39 ± 1.12 at 24 weeks postoperatively. In the follow up period, the ODI and morphine consumption significantly reduced. |
Wu et al. [23] | 2021 | Retrospective | 23 | VAS, daily morphine consumption and ODI | No local tumor progression in Follow-up imaging. | mean VAS scores, morphine consumption and ODI scores significantly decreased after treatment. |
Liu et al. [24] | 2023 | Retrospective | 58 | VAS | Tumor progression was lower in the combined-treatment group compared to VP alone (33.00% vs. 7.14%, p = 0.02). | MWA combined with PVP resulted in more sustained pain relief (>6 months) and ultimately improved quality of life with lower tumor progression and cement leakage rates, compared to PVP alone. |
Wang et al. [52] | 2024 | Retrospective | 20 | VAS, ODI and Quality of Life Questionnaire–Bone Metastases 22 (QLQ-BM22) | Local recurrence occurred in only three patients. | Baseline VAS scores (mean): 7.25 ± 0.91. |
After 1 day: 3.70 ± 1.12; | ||||||
After 1 week: 2.70 ± 0.7; | ||||||
After 1 months: 2.40 ± 0.68; | ||||||
After 3 months: 2.25 ± 0.71; | ||||||
After 6 months: 2.70 ± 0.92. | ||||||
All values were significantly lower. ODI and QLQ-BM22 significantly lower after procedure. | ||||||
Wu et al. [21] | 2024 | Retrospective | 71 | VAS, daily morphine-equivalent opioid consumption and ODI | No local tumor progression on follow-up imaging. | VAS, daily morphine-equivalent opioid consumption and ODI values significantly lower after treatment. |
Pusceddu et al. [22] | 2023 | Retrospective | 16 | VAS and ODI | No local disease recurrence was reported during a median follow-up period of 12 months. | Baseline VAS score (mean): 6.8 ± 0.7, which decreased to 0.6 ± 0.6 after treatment. ODI score decreased from 3.1 ± 0.7 to 1.2 ± 0.4. |
Pusceddu et al. [53] | 2023 | Retrospective | 28 | VAS and Functional Mobility Scale (FMS) | No local disease recurrence was reported at MRI performed 6 months after the procedure. | Combining MWA with bilateral expandable titanium SpineJack implants and VP is safe and effective, stabilizes vertebrae, relieves pain early and persistently, enhances mobility, improves walking recovery, and achieves local tumor control. |
Motaghi et al. [19] | 2022 | Retrospective | 28 | VAS | At PET/CT scan: median pre-procedure SUVmax was significantly reduced following ablation, from 4.55 to 0 over an average of 29 ± 14.1 month follow-up period. | Baseline VAS score (mean): 8 (6.5–9), which decreased to 1(1–2), 2(1–3) and 1(0.5–3) at 24 h, four weeks, and six months post procedure, respectively. |
Xiang et al. [25] | 2020 | Retrospective | 12 | VAS and ASIA neurologic grading system | Local tumor recurrence in 1 patient during follow up period. | VAS scores were 2.7 ± 0.6, 2.5 ± 0.4, 2.6 ± 0.5, and 2.5 ± 0.5 at 1, 3, 6 months after surgery and at final follow-up (significantly improved compared with baseline). |
4. Discussion
4.1. RFA and VP
4.2. MWA and VP
4.3. RFA vs. MWA
4.4. Risk of Bias
4.5. Innovative Techniques and Devices
4.6. Emerging Frontiers and Artificial Intelligence
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
MM | multiple myeloma |
RFA | radiofrequency thermal ablation |
VP | vertebroplasty |
MWA | microwave ablation |
IR | interventional radiology |
PMMA | polymethylmethacrylate |
VAS | Visual Analog Scale |
ODI | Oswestry Disability Index |
KPS | Karnofsky Performance Scale |
NRS | Numeric Rating Scale |
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Faiella, E.; Vaccarino, F.; Pacella, G.; Santucci, D.; Vergantino, E.; Bruno, A.; Ragone, R.; Zobel, B.B.; Grasso, R.F. Exploring the Efficacy of Combining Radiofrequency Thermal Ablation or Microwave Ablation with Vertebroplasty for Pain Control and Disease Management in Metastatic Bone Disease—A Systematic Review. Curr. Oncol. 2024, 31, 5422-5438. https://doi.org/10.3390/curroncol31090401
Faiella E, Vaccarino F, Pacella G, Santucci D, Vergantino E, Bruno A, Ragone R, Zobel BB, Grasso RF. Exploring the Efficacy of Combining Radiofrequency Thermal Ablation or Microwave Ablation with Vertebroplasty for Pain Control and Disease Management in Metastatic Bone Disease—A Systematic Review. Current Oncology. 2024; 31(9):5422-5438. https://doi.org/10.3390/curroncol31090401
Chicago/Turabian StyleFaiella, Eliodoro, Federica Vaccarino, Giuseppina Pacella, Domiziana Santucci, Elva Vergantino, Amalia Bruno, Raffaele Ragone, Bruno Beomonte Zobel, and Rosario Francesco Grasso. 2024. "Exploring the Efficacy of Combining Radiofrequency Thermal Ablation or Microwave Ablation with Vertebroplasty for Pain Control and Disease Management in Metastatic Bone Disease—A Systematic Review" Current Oncology 31, no. 9: 5422-5438. https://doi.org/10.3390/curroncol31090401