Anderanik Tomasian
The vertebral column is the most common site for bone metastases and is a major cause of morbidity. The current standard of care for the management of painful osseous metastases is external beam radiation, which achieves partial pain palliation, but often there is a delay in the relief of symptoms. In addition, painful osseous metastatic disease is often refractory to systemic therapies such as chemotherapy, hormonal therapy, radiopharmaceuticals, and bisphosphonates. Surgical intervention is of limited value in patients with spinal metastases, owing to its morbidity and the often poor functional status and short life span of the patients, and is typically reserved for lesions with neurologic compromise or spinal instability. Pain palliation with systemic analgesics and opioids remains the only alternative option for many patients
In this single-center study, we explored the safety and effectiveness of minimally invasive percutaneous CT-guided cryoablation for pain palliation and local tumor control for patients with painful vertebral metastatic disease. There was substantial pain palliation characterized by decreased numeric rating scale (NRS) scores and opiate/analgesic usage. Local tumor control was achieved in 96.7% of patients. Although prospective randomized trials of this therapy versus the historical standard of care, radiation therapy, will be valuable to further establish the efficacy of cryoablation for management of spine metastatic disease, our study results suggest that this minimally invasive therapy may be successfully utilized in clinical practice to achieve pain palliation and local tumor control in a select subset of patients with vertebral metastases.