Percutaneous Vertebroplasty w/MR-Guided Laser Ablation

描述（由申请人提供）：今年至少有65，000名癌症患者将出现症状性脊柱转移性病变。此外，大约30-70%的癌症患者在尸检时表现出脊柱转移，这表明随着预期寿命和存活率的增加，有问题的脊柱肿瘤的患病率将增加。脊柱肿瘤通常是极其痛苦和衰弱的病人。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、缓解疼痛、保护神经功能和稳定脊柱。经皮椎体成形术，即将液体骨水泥注入受影响的椎体体内，已成为治疗脊柱转移瘤的常用方法。目前，椎体成形术与肿瘤缩小术联合进行，最常见的是通过放疗或化疗。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。在第一阶段，我们提出将肿瘤的靶向热消融与经皮椎体成形术结合起来作为一种单一的治疗技术，这是一种有效的方法，可以一次实现目前治疗的所有目标。我们在动物模型中证明了这种技术的可行性，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控制病变大小。该系统可能是理想的指导安全激光消融脊柱肿瘤结合椎体成形术。在本提案中，我们将在动物中进一步开发该技术，目标是将该系统移植到新的介入图像引导手术设施中进行评价。与医学部的介入放射科医生合作。安德森癌症中心在得克萨斯州休斯顿，我们将评估程序在一个小的人类临床研究。

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.