Zapping Away Spinal Tumors
OAKLAND, Calif. (Ivanhoe Newswire) - Two-thirds of cancer patients will have their disease spread to their bones. The spine is the most common site and it can mean severe pain as tumors grow and press on nerves. Now, there's a new way to heat up and zap away the cancer.
A simple walk is a victory for Michaelene D'Ambrosio. Six months ago, she was diagnosed with stage IV breast cancer.
"Seventy percent of my breast tissue was tumor," Michaelene told Ivanhoe.
That tumor had spread to her spine, causing severe pain.
"I couldn't bend. I couldn't reach. I couldn't walk. The pain was just constant," Michaelene said.
"It was heartbreaking," Ashley Johnson, Michaelene's granddaughter, told Ivanhoe.
Then Michaelene found Dr. Rakesh Donthineni who treats spinal tumors with STAR ablation.
"The goal is truly to kill the tumor," Rakesh Donthineni, MD, Cancer Specialist for Spine and Extremities, told Ivanhoe.
First, he inserts a needle into the spine. Next, he ablates the tumor with heat that reaches 100 degrees or more. Then, he fills in the hole with cement. The ablation doesn't carry the same side effects as traditional chemo or radiation, and 95 percent of patients report pain relief.
"You're reducing the size of the tumors. You're reducing the effects on improving the quality of life, and that's the goal in these patients," Dr. Donthineni told Ivanhoe.
"I have been pain-free since the surgery," Michaelene said.
Now, pain doesn't get in the way of spending precious time with her granddaughter Ashley.
The doctor says he can ablate multiple tumors at the same time. Patients may experience some back pain and there's always a risk that the tumors can grow back. The procedure typically takes 45 minutes from start to finish.
BACKGROUND: A spinal tumor can affect the nerves surrounding the tumor and may lead to neurological problems such as paralysis. Spinal tumors may cause permanent disability even if the tumor is benign. Once the tumors grow, they can affect bones of the spine, nerve roots, blood vessels, and spinal cord cells. Leukemia, myeloma, and lymphoma are all types of tumors that can occur in the spine. (Source: http://www.mayoclinic.com/health/spinal-tumor/DS00594and http://www.nlm.nih.gov/medlineplus/ency/article/001403.htm)
CAUSES: In most cases, it is unclear why spinal tumors are formed. Some doctors will say that genetics is a big underlying factor. For example, there have been cases where spinal tumors have been linked to inherited syndromes like von Hippel-Lindau disease and neurofibromatosis type 2. Spinal tumors affect the vertebrae, which are made up of small bones that are stacked on top of one another, protect the nerve root and spinal cord. The spinal cord is a long column of nerve fibers that carry messages to the brain. These parts of the spine are the most likely to be affected by spinal tumors. (Source: http://www.mayoclinic.com/health/spinal-tumor/DS00594/DSECTION=causes)
SYMPTOMS: Symptoms of a spinal tumor vary depending on the location and type of the tumor. Typically, symptoms include:
- Back pain, often radiating to other parts of your body
- Decreased sensitivity to pain, heat and cold
- Difficulty walking, sometimes leading to falls
- Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves are compressed. (Source: http://www.mayoclinic.com/health/spinal-tumor/DS00594/DSECTION=causes)
NEW TECHNOLOGY: A radiofrequency (RF) ablation procedure performed with the STAR™ Tumor Ablation System is a dramatic step forward in the palliative treatment of metastatic spinal tumors. Accessing the tumor may only require local anesthesia with conscious sedation and a small incision. As with most surgical procedures, serious adverse events can occur. Risks can include: pain, infection, hematoma, hemorrhage, and nerve injury leading to radiculopathy, paresis, or paralysis, damage to surrounding tissue through iatrogenic injury, hemothorax or pneumothorax, unintended puncture wounds, and pulmonary embolism. (Source:http://www.dfineinc.com/physician/star-tumor-ablation-procedure)
Rakesh Donthineni, MD, Cancer Specialist for Spine and Extremities, talks about a new treatment for spinal tumors.
What I didn't realize is that in a lot of cancers, when they get to stage four, they appear in other parts of your body and a lot of times maybe your spine, is that correct?
Dr. Donthineni: What happens is as we are making better treatments for primary cancers such as prostate, breast, lung, etc., we're getting better at treating and people are living longer, which essentially means that they have more metastatic disease. They are suffering from those, which then becomes a problem so we have to manage their metastatic disease to make sure that their lives are functioning well.
What percentage of people who have stage four cancers will get something in their spine?
Dr. Donthineni: A very, very high percentage. There were some cadaver studies that showed more than fifty, maybe seventy, eighty percent having cadaver spine lesions or bone lesions. But truly presenting in the office setting or having symptoms could be thirty, forty percent or more.
What does that mean for a cancer patient then?
Dr. Donthineni: Back pain and sometimes it's gradually progressing, sometimes it's acute. They suddenly build up back pain from the smallest of functions. Maybe they're bending or leaning or lifting something and it hurts. Of course if their tumor is big, if it starts growing bigger what happens is they can push on the spinal cord or the nerves and cause other sorts of pain. But usually it's pain in the midline and the neck or upper back or lower back. And it can be pretty miserable.
Do you think it's more painful to have secondary lesions than it is to have the cancer sometimes?
Dr. Donthineni: Yes, very much so because the primary tumor itself is a problem and it can be treated, but once it starts spreading and it's out of control their lives can be pretty disabled.
Is there a reason why it might go to the spine? Is it more likely than any other place to go to the spine?
Dr. Donthineni; It can go to the pelvis or other parts but there are just more bones in the spine overall, but blood supply depends on which tumor. Some tumors will have more predilections for the spine, others don't.
Before this ablation what could you do for people who would come in with spine lesions?
Dr. Donthineni: We do radiation, of course chemotherapy; but local control is important. And then treatment of that lesion itself is important. Bracing it internally or externally is important.
What can you do for them now?
Dr. Donthineni: The other option is to actually put cement in to the cavities of the bone to give them a better internal support before they collapse or if they've started to collapse. The only problem with that is if the tumors are still sitting there and there's no cavity or there's still potential to grow you'll be good to actually destroy the tumor. And really frequency ablation is a pretty good option.
How long have you been doing this?
Dr. Donthineni: I've actually done a few cases a few years ago but uh—with the star system more recently within the year.
So, literally what you're doing is killing the tumor from the inside out?
Dr. Donthineni: Correct.
How does that work?
Dr. Donthineni: It works very well, you're giving it a very focused treatment within the lesion. You're getting a cavity that's created because you're actually killing the tumor. And the cavity, once it's created, you're filling it with cement to give it a little support, internal support. Some sort of a mechanical support.
Can you explain to me how you do it because it seems not a invasive as surgery?
Dr. Donthineni: Once you identify the level that's involved the patient is given anesthesia, whether a sedation or something deeper. Once they're comfortable — that's the key — we use imaging studies, whether it's fluoroscopy or CT scan. I use fluoroscopy. It's fluoroscopy and bullet plane so it's called biplane to give me more information and be more accurate. And then once I identify the correct level I make a small, tiny little incision probably less than half a centimeter and I pass a needle in to the spine through some safe zones. Once I'm in the spot that I should be at then we treating the radiofrequency ablation of the tumor.
Now it seems a little dangerous to be putting heat in to the spine; is it?
Dr. Donthineni: Well the purpose of the heat is to kill the tumor, so you're right, there is a danger it can kill other tissues as well. But if we are careful, if we understand anatomy and surgically we know the anatomy and necessary skills etc., and we have the fluoroscopy or other imaging studies to help us locate the tip correctly then we should be in a safe zone.
How hot does it get?
Dr. Donthineni: A hundred plus degrees.
Is it immediate relief, they wake up from surgery and feel a difference?
Dr. Donthineni: I mean there's a whole range. I mean we can have ones who feel the cementation helps support the back and so they feel better. There are other ones who you have some improvement, but they need other care. We work closely in conjunction with the oncologist, radiation oncologist, etc. So if we think the treatment is adequate, then they progress to some other management.
You're not curing these patients of their cancer but you're giving them kind of like their life back, a quality of life for their end of life?
Dr. Donthineni: Correct. This is not a cure, a true cure as much as you're reducing the size of the tumors, you're reducing the effect on improving the quality of life. And that's the goal in these patients.
Are there any bad side effects?
Dr. Donthineni: Well, of course the tumors can grow back. That's the risk and we watch them, monitor them etc. The second thing is there are nerves close by but the risk is pretty small. There can be some back pain because of the needle and placement of the needle. But again it's a very small incision and patients are often sent home the same day.
How many can you do at a time?
Dr. Donthineni: Oh three, four, five. It depends on how long the sedation is and how long the surgeons' tolerance is.
Are there any tumors that you wouldn't do?
Dr. Donthineni: I guess the trick becomes when the tumors actually break out of the back of the spine and go in to the spinal canal. There we have to be careful because the spinal cord the nerves are there and we can still treat them but it becomes a little bit more tricky, we have to be more careful, diligent and attend to it so that we treat the tumor but now having the side effects.
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