PVP with or without microwave ablation for the treatment of painful spinal metastases from NSCLC: a retrospective case-control study

Figures & data

Figure 1. the workflow Schematic diagram of this study. NSCLC, non-small cell lung cancer; VAS, visual analog scale; MWA, microwave ablation; PVP, percutaneous vertebroplasty; QoL, quality of life; LTP, local tumor progression.

Table 1. Baseline clinicopathological characteristics of patients in both groups.

Characteristics	Group A (n = 30)	Group B (n = 28)	p Value
Age (mean ± SD, range) (year)	59.50 ± 10.18, 39–75	56.14 ± 9.74, 38–73	0.21
Sex (male/female)	20/10	14/14	0.28
Pathological type (SC/AC/Others)	7/20/3	6/18/4	0.93
Max diameter (mean ± SD) (cm)	2.81 ± 0.48, 2.0–3.8	2.95 ± 0.58, 1.8–4.0	0.35
Lesion location (thoracic/lumbar vertebra)	6/24	5/23	0.84
Type of destruction (osteolytic/mixed)	19/11	20/8	0.51
Posterior wall involvement (yes/no)	9/21	7/21	0.67
Vertebral body compression (yes/no)	10/20	8/20	0.70
Symptom duration (≤ 1/1–4/≥ 4 weeks)	6/16/8	5/20/3	0.30
ECOG score (0/1/2/3)	3/11/10/6	2/9/12/5	0.90
Karnofsky score (mean ± SD)	69.67 ± 5.56	69.29 ± 5.39	0.79
DMC (mg) (mean ± SD)	95.33 ± 16.91	100.54 ± 15.17	0.22
VAS (mean ± SD)	7.53 ± 1.36	7.32 ± 1.09	0.49
ODI (mean ± SD)	50.53 ± 11.71	50.18 ± 11.42	0.91
Smoke abuse (yes/no)	18/12	20/8	0.36
COPD (yes/no)	9/21	9/19	0.86
Biochemical index (mean ± SD)
White blood cell (×10^9/L)	5.69 ± 1.29	5.73 ± 1.17	0.91
Platelet (×10^9/L)	175.17 ± 31.03	169.96 ± 23.87	0.35
Hemoglobin (g/L)	124.83 ± 16.02	128.50 ± 13.62	0.48
Albumin (g/L)	33.93 ± 5.37	35.79 ± 5.92	0.22
Prothrombin time (s)	16.31 ± 1.65	16.93 ± 1.39	0.13
Glutathione aminotransferase (U/L)	37.83 ± 8.93	36.93 ± 6.75	0.67

SD: standard deviation; SC: squamous carcinoma; AC: adenocarcinoma; ECOG: Eastern Cooperative Oncology Group performance status; DMC: daily morphine consumption; VAS: visual analogue scale; ODI: Oswestry disability index; COPD: chronic obstructive pulmonary disease.

Figure 2. A 61-year-old Female patient with thoracic vertebra 10 (T10) metastases from NSCLC, and VAS score was 7 at pre-procedure (A-C). (A) the 13 G puncture needle was inserted into the T10 under the guidance of C-arm computed tomography (CT) and fluoroscopy, and intra-operative C-arm CT showed that metastases damaged the integrity of the T10 (arrow); (B) bone cement was slowly injected under real-time fluoroscopy; (C) intra-operative C-arm CT showed adequate filling of the bone cement in the T10, and the VAS score decreased to 2 at 1 week evaluation. Another 57-year-old male patient with lumbar vertebra 4 (L4) metastases from NSCLC, and VAS score was 8 at pre-procedure (D-F). (D) the 13G puncture needle was inserted into the L4 under the guidance of C-arm CT and fluoroscopy, intra-operative C-arm CT showed that metastases damaged the integrity of the L10 (arrow), and a MWA applicator was inserted into the L4 by coaxial technology; (E) the location of puncture needle and applicator were confirmed by real-time fluoroscopy; (F) intra-operative C-arm CT showed adequate filling of the bone cement in the L4, and the VAS score was reduced to 2 at 1 week evaluation.

Table 2. Intraoperative and postoperative parameters from different therapy strategies.

Parameters	Group A (n = 30)	Group B (n = 28)	p Value
Technical success (%)	100%	100%	–
Total procedure time (mean ± SD) (minutes)	36.52 ± 7.13	41.28 ± 6.85	0.01
Fluoroscopy effective dose (mean ± SD) (mSV)	14.17 ± 4.27	15.78 ± 3.86	0.14
Number of intraoperative CACT scans (mean ± SD)	2.47 ± 0.73	2.32 ± 0.61	0.42
Cement volume (ml)	3.47 ± 0.64	3.87 ± 0.57	0.01
Ablation time of MWA (mean ± SD) (minutes)	–	3.18 ± 0.71	–
Microwave power (mean ± SD) (W)	–	32.86 ± 5.17	–
Complications (n, %)	16 (53.33%)	4 (14.29%)	0.02
Small hematoma at the puncture site	4 (13.33%)	2 (7.14%)	0.67
Cement leakage	12 (40.00%)	2 (7.14%)	0.03
Local tumor progression (n, %)	10 (33.33%)	2 (7.14%)	0.02
Follow up time (median, range) (months)	14.4 (6.2–18.0)	16.5 (5.5–19.6)	0.28
Follow-up treatments (C/R/TT/IT/others)	26/4/20/9/11	26/4/17/12/15	0.88

Bold values are statistically significant at p < 0.05.

SD: standard deviation; CACT: C-arm computed tomography; C: chemotherapy; MWA: microwave ablation; R: radiotherapy; TT: target therapy; IT: immunotherapy.

Figure 3. Changes of the indicators in both groups at different times. (A) trends in visual analog scale (VAS) scores over time in both groups; (B) trends in daily morphine consumption (DMC) over time in both groups; (C) stratification analysis of VAS grades between two groups at different times; (D) trends in Oswestry Disability Index (ODI) over time in both groups; (E) trends in Karnofsky score over time in both groups; (F) at 24 weeks (T24), comparison of sleep, appetite, fatigue, and spiritual scores between two groups.

Table 3. Pain relief and ODI evaluation at both groups.

Indicators, Mean ± SD	VAS		p Value	DMC (mg)		p Value
	Group A	Group B		Group A	Group B
T0	7.53 ± 1.36	7.32 ± 1.09	0.49	95.33 ± 16.91	100.54 ± 15.17	0.22
T1	2.27 ± 0.52	2.43 ± 0.57	0.23	18.83 ± 3.64	16.79 ± 5.48	0.10
T4	1.73 ± 0.83	1.64 ± 0.78	0.74	11.00 ± 3.05	10.00 ± 5.27	0.89
T12	1.57 ± 0.82	1.50 ± 0.96	0.98	8.17 ± 5.17	7.32 ± 4.81	0.64
T24	1.93 ± 1.14	1.29 ± 0.94	0.03	9.73 ± 6.73	5.54 ± 3.93	0.01

Bold values are statistically significant at p < 0.05.

SD: standard deviation; VAS: visual analog scale; DMC: daily morphine consumption; T0: pretreatment; T1: 1 weeks; T4: 4 weeks; T12: 12 weeks; T24: 24 weeks.

Table 4. Univariable and multivariable analyses of predictors of cement leakage.

Variables	Univariable	Multivariable
	P value	OR	95% CI	p Value
Gender (male/female)	0.498	–	–	–
Age (> 60/≤ 60 years old)	0.296	–	–	–
Pathological type (SC/AC/Others)	0.153 /0.509	–	–	–
Type of destruction (osteolytic/mixed)	0.463	–	–	–
Max diameter (≤ 3.0/> 3.0 cm)	0.027	0.272	0.026–2.877	0.279
Lesion location (thoracic/lumbar vertebra)	0.312	–	–	–
Posterior wall involvement (yes/no)	0.618	–	–	–
Vertebral body compression (yes/no)	0.001	21.553	1.651–281.302	0.019
ECOG score (> 2/≤ 2)	0.552	–	–	–
Number of intraoperative CACT scans (≤ 2/> 2)	0.202	–	–	–
Fluoroscopy dose (> 15/≤ 15 mSV)	0.704	–	–	–
Cement volume (> 3.5/≤ 3.5 ml)	0.060	10.611	0.612–183.960	0.105
Treatment allocation (MWA + PVP/PVP alone)	0.024	0.131	0.019–0.927	0.042

Significance of the bold values in Univariate variables with p < 0.1 were included in the multivariate logistic regression model.

Bold values are statistically significant at p < 0.05.

OR: odds ratio; CI: confidence interval; SC: squamous carcinoma; AC: adenocarcinoma; ECOG: Eastern Cooperative Oncology Group performance status; CACT: C-arm computed tomography; MWA: microwave ablation; PVP: percutaneous vertebroplasty.

Data availability statement

In addition to the raw data in the manuscript, the datasets used are available from the corresponding author on reasonable request.