Vertebral augmentation, with or without radiofrequency ablation, safely improved pain at 4 weeks in patients with cancer with spinal fractures, including those with posterior vertebral body wall disruption.

To evaluate the use of the Superion (Boston Scientific) percutaneous interspinous process spacer (IPS) for the treatment of neurogenic intermittent claudication (NIC) in cancer patients due to lumbar spinal stenosis (LSS) and explore the special therapeutic advantages, considerations, and challenges involved in treating the cancer patient population This single-institution retrospective study evaluated the treatment of 15 lumbar vertebral levels in 9 cancer patients (6 men, mean age 71 years). Eligible patients included those with clinical signs and symptoms consistent with NIC. Outcomes were assessed based on patient-reported pain scores (Brief Pain Inventory, BPI) and imaging metrics. LSS was due to a variety of factors in the study population, including disc bulge (7/9), facet arthropathy (4/9), ligamentum flavum thickening (6/9), and epidural tumor (3/9). There was a significant improvement in pain scores following IPS (median pre = 7, post = 3, P = 0.005). Likewise, there was significant improvements in cross-sectional areas of the central canal (median percent increase 16.9, P < 0.001) and bilateral neuroforamina (right = 22.5, P = 0.007; left = 33.5, P = 0.002) following IPS placement. There was no delayed incisional healing despite prior lumbar spine radiation (3/9 patients). One patient experienced an asymptomatic complication of spinous process fracture following the procedure. IPS is safe and effective for the treatment of NIC in cancer patients. Although life expectancy in this patient population may be less than that of the general population, pain palliation remains a meaningful and achievable goal with this minimally invasive technique.

To evaluate the safety and efficacy of radiofrequency ablation and cement augmentation for the treatment of secondary metastases to the spine This single-institution retrospective study evaluated the treatment of 332 lesions in 165 patients (94 men, mean age 64 years) over a 2-year period (2017 – 2019). Percutaneous radiofrequency ablation (RFA) and cement augmentation was performed under fluoroscopic or computed tomography guidance; kyphoplasty versus vertebroplasty was performed at the discretion of the provider. Treated levels included upper thoracic (39/332), lower thoracic (121/332), and lumbar (172/332) vertebral bodies. The majority of treated levels (262/322, 81%) resulted in a substantial improvement in pain ( > 2-point reduction in Brief Pain Inventory scale following the procedure). Based on univariable and multivariable analysis, significant predictors of treatment failure included cancer type (melanoma, hematologic malignancies; P < 0.001), age > 70 years (P = 0.03), and interventional imaging modality (fluoroscopy, P = 0.01). Cement leakage occurred in 19% (61/322) of treated levels, though leakage was asymptomatic in all but 1 patient; posterior vertebral body wall erosion due to tumor was present in 19% (62/322) of treated levels and was not associated with leakage. However, use of RFA was significantly associated with a decreased rate of leakage (P = 0.003). No patients experienced spinal cord or spinal nerve injury following RFA. Radiofrequency ablation and cement augmentation is a safe and effective treatment for painful spinal metastasis.

To evaluate the use of volumetric enhancement of hepatocellular carcinoma (HCC) lesions on dual-phase C-arm cone-beam computed tomography (DP-CBCT) acquired immediately before drug-eluting beads transarterial chemoembolization (DEB-TACE) as a predictor of tumor response. This single-institution retrospective study was HIPAA-compliant and IRB-approved. 16 HCC lesions in 16 patients (10 men, mean age: 66.1 years) were treated with DEB-TACE. Three sets of images were obtained for each patient: Baseline contrast enhanced magnetic resonance imaging (CE-MRI) 4-6 weeks before TACE, intra-procedural DP-CBCT immediately before TACE, and CE-MRI 4-6 weeks post TACE. Volumetric tumor enhancement on arterial phase images was assessed on a voxel-by-voxel basis for all modalities and characterized using qEASL criteria. Findings on follow-up MRI were compared to baseline MRI to assess response and this response was compared to findings on DP-CBCT assessed immediately before therapy using linear regression. The mean enhancement on DP-CBCT was calculated and used as a threshold to separate patients into two groups. Each group was then correlated separately with treatment response. The relative tumor enhancement (in %) observed immediately before therapy on DP-CBCT demonstrated a strong correlation with therapy-related reduction of MR enhancement (R2 = .835; P < .0001). Patients with greater relative volumetric enhancement of lesions directly before TACE demonstrated substantially higher reduction of volumetric enhancement on follow-up MRI and thus a higher rate of response. 6/16 patients were classified as responders according to qEASL criteria. The mean enhancement calculated on DP-CBCT was 55.3% and separated patients into two groups of 8. Enhancement below the mean on DP-CBCT was correlated with 0% response at follow-up while enhancement above the mean was associated with 75% response. 3D quantitative assessment of HCC lesionenhancement on DP-CBCT immediately before DEB-TACEis strongly coorelated with volumetric reduction of tumorenhancement on follow-up CE-MRI.Greater tumorenhancement on DP-CBCT immediately prior to treatmentmay be an early predictor of treatment response.

The clinical management of hepatocellular carcinoma has evolved greatly in the last decade mostly through recent technical innovations. In particular, the application of cutting-edge image guidance has led to minimally invasive solutions for complex clinical problems and rapid advances in the field of interventional oncology. Many image-guided therapies, such as transarterial chemoembolization and radiofrequency ablation, have meanwhile been fully integrated into interdisciplinary clinical practice, whereas others are currently being investigated. This review summarizes and evaluates the most relevant completed and ongoing clinical trials, provides a synopsis of recent innovations in the field of intraprocedural imaging and tumor response assessment, and offers an outlook on new technologies, such as radiopaque embolic materials. In addition, combination therapies consisting of locoregional therapies and systemic molecular targeted agents (e.g., sorafenib) remain of major interest to the field and are also discussed. Finally, we address the many substantial advances in immune response pathways that have been related to the systemic effects of locoregional therapies. Knowledge of these new developments is crucial as they continue to shape the future of cancer treatment, further establishing interventional oncology along with surgical, medical, and radiation oncology as the fourth pillar of cancer care.