Percutaneous Vertebroplasty w/MR-Guided Laser Ablation

描述(申请人提供)：今年至少有65,000名癌症患者会出现有症状的脊椎转移灶。此外，大约30%-70%的癌症患者在尸检中表现出脊柱转移，这表明随着预期寿命和生存率的增加，有问题的脊柱肿瘤的患病率将会增加。脊椎肿瘤对患者来说常常是极度痛苦和虚弱的。转移性脊柱病变的治疗策略本质上是姑息性的，目标是减少肿瘤质量、减轻疼痛、保护神经功能和脊柱稳定。经皮椎体成形术，即将液体水泥注入受影响椎体，已成为治疗脊柱转移瘤的流行方法。目前，椎体成形术是在肿瘤缩小的同时进行的，最常见的方法是放射或化疗。这种双重治疗方法增加了管理成本，并可能使患者持续疼痛，直到两种治疗方案都完成为止。在第一阶段，我们建议将肿瘤的靶向热消融和皮下椎体成形术作为一种单一的治疗技术，这是一次有效地实现当前治疗的所有目标。我们在动物模型中证明了这项技术的可行性，并表明磁共振图像引导的激光治疗可以可视化激光加热和安全地控制病变大小。该系统可能是指导脊柱肿瘤激光消融与椎体成形术相结合的理想方法。在这项提案中，我们将在动物身上进一步开发这项技术，目标是将该系统移植到一种新的介入性图像引导手术设施进行评估。然后，我们将与德克萨斯州休斯敦安德森癌症中心的介入放射科医生一起，在一项小型人类临床研究中对该手术进行评估。

DESCRIPTION (provided by applicant): At least 65,000 cancer patients will develop symptomatic spinal metastatic lesions this year. Additionally, approximately 30-70% of all cancer patients exhibit spinal metastasis at autopsy indicating that the prevalence of problematic spinal tumors will increase as life expectancies and survival rates increase. Spinal tumors are often excruciatingly painful and debilitating to the patient. Treatment strategies for metastatic spinal lesions are palliative in nature and are targeted toward reduction of tumor mass, alleviation of pain, preservation of neurological function, and stabilization of the spinal column. Percutaneous vertebroplasty, whereby liquid cement is injected into the body of the affected vertebra has become a popular method for managing spinal metastases. Currently, vertebroplasty is performed in conjunction with tumor reduction most often through radiation or chemotherapy. This dual treatment approach increases the cost of management and may leave patients with continuing pain until both treatment regimens have bean completed. In Phase I, we proposed coupling targeted thermal ablation of tumors with parcutaneous vertebroplasty as a single treatment technique, which is effective at accomplishing all the goals of current therapies at once. We demonstrated the feasibility of this technique in an animal model and showed that magnetic resonance image guided laser therapy allows visualization of laser heating and safe control of lesion size. This system may be ideal for guidance of safe laser ablation of spinal tumors in conjunction with vertebroplasty. In this proposal, we will further develop this technique in animals with the goal being to port the system to a new interventional image-guided surgery facility for evaluation. In conjunction with interventional radiologists at the M.D. Anderson Cancer Center in Houston, Texas, we will then evaluate the procedure in a small human clinical study.