A new way to destroy cancer cells in the spine
Metastatic bone cancer is notoriously painful, especially when located in the spine, and often interferes in actively participating in normal life. Analgesic medications provide limited periods of relief and can have bothersome side effects.
Now, a new technology available at Cape Cod Healthcare can reduce pain and improve quality of life for these patients.
The OsteoCool ™ Radio Frequency (RF) Ablation system, which received FDA approval in January of this year, delivers precision-guided energy to destroy cancer cells within the spine. This is not the first system to do so, but it is the only one using dual probes and a built-in cooling mechanism to allow for better preservation of healthy tissue. It also has the ability to perform other procedures, like kyphoplasty, at the same time.
“Traditionally, there are a variety of strategies to manage a cancer patient’s pain as it relates to tumor. This particular technique is used in conjunction with other gold standard methods for treating pain,” said Cape Cod Hospital neurosurgeon Nicholas Coppa, MD.
The procedure is also helpful in controlling the growth of a metastatic bone tumor.
“It does provide some sort of therapy, meaning that it can reduce the progression of cancer within that vertebral body or within that bone. In doing so, you may prevent neurological deficits that occur as a result of tumor progression,” said Dr. Coppa.
Who Is A Candidate?
The OsteoCool ™ RF Ablation system serves patients who have painful metastatic cancer, which is cancer that has spread from its original site in the body. The most common site of metastatic bone cancer is the spine.
The OsteoCool procedure is also an option when the cancer has caused neurological deficits in the patient, according to Dr. Coppa.
“A lot of patients with cancer of the spine have spinal cord compression and instability issues, or nerve root compression, in which your treatment goals are more than mitigating pain,” he said.
This system is not used to treat primary cancer of the spine, he said.
“There is a whole different strategy to treat cancers that originate in the bone, like osteosarcoma.”
How Does It Work?
The OsteoCool™ RF Ablation system uses X-ray images taken before treatment to guide the equipment.
“The system can be programmed so that a very defined and predictable amount of lesion volume can be identified. It uses pre-operative image studies to figure out where you need to position the probes within the bone,” said Dr. Coppa.
Patients undergoing treatment are placed in the prone position and are given both sedation and a local anesthetic. One or two probes are then inserted into the cancerous tissue. Radiofrequency energy delivers high heat for a calculated period of time to kill the tumor cells.
Start to finish, it takes from 15 to 30 minutes to successfully treat each lesion. In most instances, each session is limited to one or two lesions at a time.
Once the cancer is destroyed, there may be a need to stabilize the area and attend to small fractures that are often present in these cases.
“After the procedure, it allows us to perform a kyphoplasty, where you insert a balloon through the probe and inject cement into the involved vertebrae. That ultimately is what eliminates pain,” said Dr. Coppa.
In most cases, patients are able to go home the same day.
What Are The Risks And Benefits?
The risks of this procedure are the same as those associated with other treatments of the spine, according to Dr. Coppa. In all cases there is a potential for neurological deficit, something he said he has never encountered.
But the benefits of the OsteoCool ™ RF ablation system may far outweigh the small potential for harm. Pain relief is the biggest benefit and it is often felt immediately.
“When we visit patients in the recovery room and ask them to move around, they can appreciate a difference that quickly,” said Dr. Coppa.
And for people struggling with their disease, pain relief may be the difference between a sedentary or active life.
“I don’t judge success by a pain scale number. I judge success by ‘do you feel better and are you doing more throughout the day? Are you spending more time out of bed? Are you engaging in activities of daily living more so then you were before surgery?’ To me, improving somebody’s functional capacity is a success,” he said. “The ultimate goal is reduced pain so that you can do more.”
The results have been so positive that this procedure has made its way into the guidelines for standard of care when treating metastatic cancer to the spine, said Dr. Coppa.
[Featured Images via Medtronic.]