Pelvik Halka Malign Kemik Metastazlarının Tedavisinde Radyofrekans Ablasyon ve Çimentolama Kombine Tedavisinin Başarısı ve Güvenilirliği

Abstract

After the lungs and liver, one of the most common organs for malignant tumors to metastasize is the bone. Bone metastases seen in malignant tumors cause significant morbidity, leading to problems such as pain and walking difficulties. Managing chronic bone pain associated with malignant metastases requires a multidisciplinary approach involving surgery, radiation therapy (RT), medical treatments, and ablation therapies. The importance of minimally invasive surgical procedures is increasing over time, particularly for patients resistant to medical treatments. Within the scope of this thesis, the main aim is to demonstrate that combined percutaneous RF ablation and cementoplasty is an effective treatment for pain palliation and enhancement of functional capacity in malignant pelvic and sacral metastases. The study retrospectively evaluated data from 20 patients with bone metastases to pelvic bones and sacrum who underwent surgery at Hacettepe University between January 2014 and December 2021. All patients were selected based on the combination of RF ablation and cementoplasty treatments, being above the age of 18, having a life expectancy of more than 1 month, and having preoperative and postoperative follow-ups for the first month. Using patient records, VAS, Karnofsky Performance Status (KP), and MSTS scores were calculated for preoperative and subsequent follow-up visits. Additionally, the walking capacity of patients, including abilities to climb stairs, use public transportation, and put on socks, as well as the use of assistive devices and limping, were evaluated for preoperative and postoperative follow-ups. The KT, RT and bisphosphonate treatments received by patients before and after surgery were identified. In the study, the average preoperative VAS value was calculated as 7.15 (SD = 2.834), the average VAS value at the first postoperative control was 4.7 (SD = 1.922), the average VAS value in the 3rd month was 3.06 (SD = 2.323), the average VAS value in the 6th month was 2.17 (SD = 2.443), and the average VAS value in the 12th month was 2.5 (SD = 3.423). The reduction in values between preoperative and postoperative in 3, 6, and 12 months was statistically significant (p = 0.006). The average preoperative Karnofsky Performance (KP) value was 61.5 (SD = 25.189), the average KP value in the 3rd month was 81.88 (SD = 19.738), the average KP value in the 6th month was 86.670 (SD = 10.731) and the average KP value in the 12th month was 83.75 (SD = 16.850). When comparing preoperative and postoperative KP values, the increase in values in 3, 6, and 12 months was statistically significant (p <0.05). While an increase in postoperative MSTS values compared to preoperative values was observed, it was not statistically significant (p = 0.083). An increase in the ability to climb stairs and walk was observed in postoperative follow-ups compared to preoperative ones, while the use of assistive devices significantly decreased. Cement leakage outside the lesion was observed in 5 patients (25.0%), and no symptoms related to this leakage were observed in the patients. The average lesion cement filling ratio was found to be 0.708 ± 0.236 (Min = 0.18; Max = 1). Correlation relationships between lesion filling ratio and VAS, Karnofsky Performance Scale, and MSTS scores were not statistically significant (p> 0.05). A negative correlation was found between the 3-month MSTS measurement and age, R=-0.577, moderate (p = 0.019 <0.05); a strong negative correlation (R =-0.796) was found between postoperative 3-month KP value and age, at a high level (p = 0.000 <0.05). Correlation relationships between age and VAS were not statistically significant (p> 0.05). In our study, it has been shown that combined RF ablation and percutaneous cementoplasty treatment is an effective treatment for pain and functionality. Considering the scarcity of research focused on patients' functional well-being, the substantial significance lies in our study's dual-score assessment of this aspect. Our investigation delved into the impact of factors such as age, lesion-filling ratio, and cement leakage on pain and functional metrics, yielding noteworthy findings that have the potential to pave the way for forthcoming research endeavors.