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Spokane, Washington  Est. May 19, 1883
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STAR treatment: Radiofrequency energy used to kill tumors in vertebrae

Treva Lind

Cancer patient Jeff Hinz of Post Falls calls it a nuke, delivered by a new medical device that targets radiofrequency energy to heat and kill tumors in vertebrae, normally a tricky area for such precision.

“My understanding is they ablate the tumor, nuke it,” said the 43-year-old Hinz, diagnosed fall 2013 with lung cancer that spread to bones. “With this procedure, you’re in and out in one day and walk out of the hospital. You’re a little sore for a day or two, but there’s no major incisions.”

Called spinal tumor ablation radiofrequency, or STAR, the procedure with the specialized instrument was developed by San Jose-based medical device company DFINE. STAR rolled out into a limited number of U.S. medical sites in 2012, and to date, and it’s treated a little more than 2,200 tumors.

About 1.7 million Americans are diagnosed each year with cancer, and two-thirds of them develop bone metastasis, often in the spine. The pressure from tumors in the spine can cause extreme pain and fractures.

During STAR procedures, physicians also use the device to insert liquefied bone cement in spots where the tumors are destroyed, and that substance quickly hardens to stabilize the bone.

Dr. Jayson Brower, Inland Imaging interventional radiologist, began doing STAR procedures and using the needle-like probe on Spokane-area patients about a year ago, including three outpatient procedures since April to destroy tumors in Hinz’s spine. Each outpatient session took no more than an hour.

Last week, Hinz returned for another treatment at Providence Sacred Heart Medical Center, but this time, a tumor wasn’t zapped. Brower used the device on Dec. 18 to insert cement in a painful area of his collarbone weakened and fractured from cancer treatments. Hinz said he walked away pain-free after a 90-minute recovery. The Post Falls High School football coach planned to teach the next day.

Medical treatments applying radiofrequency energy have been around for awhile, but STAR opens up new fronts to work in the spine, Brower said. Inland Imaging is contributing to DFINE’s research trials for STAR, and Brower said about 50 local patients have undergone the procedure so far.

Doctors rely on X-ray guidance to move the steerable instrument to the correct vertebrae. The device has a small transmitting antenna to deliver the targeted radiofrequency energy that heats the tumor to more than 120 degrees, and that heat destroys the metastatic tumor cells, Brower said.

“Without this device, we couldn’t do this type of procedure in the spine,” Brower said. “It’s steerable device, so we can safely move to the different parts of the spine that need to be treated, and this probe was specifically designed and reinforced to work in the bone.”

The device also has safety mechanisms, he said. “We have to be careful of the spinal cord and nerves, and the device has built-in sensors that help us minimize any potential damage to the nerves.”

Patients typically receive a combination of local anesthesia and moderate sedation with medicine or through an IV, so they are comfortable and relaxed but can respond, Brower said.

Before the STAR procedure, Brower said patients had two ways to combat pain from tumors in the spine: with narcotics such as morphine that leave patients feeling groggy, or palliative radiotherapy requiring multiple radiation treatments at a hospital.

Hinz said he had some pain in his spine, although not excruciating. He and doctors were more concerned about evidence of cracking in vertebrae. His STAR procedures removed pain and destroyed specific tumors, he said, and use of cement also should prevent major bone surgery.

“My oncologists at Cancer Care Northwest recommended this procedure with Dr. Brower,” he said. “They noticed there was cracking, and they felt if it fully collapsed, I’d be facing serious back surgery. So one, this is to alleviate the pain, and two, to alleviate any major surgeries like putting rods in my back.”

For overall cancer treatment, he still undergoes a schedule of two-hour chemotherapy every three weeks. Recent scans have shown the cancer isn’t growing or spreading, he said.

In the spine, a tumor causes pain as it puts pressure on the bone, surrounding structure, and sometimes nerves, Brower said.

“Sometimes the tumor then will cause a fracture of the spine,” Brower said. “This device destroys the tumor so it will minimize or eliminate the pain. With the special cement placed where the tumor is destroyed, it stabilizes almost like an internal cast, and that helps prevent and eliminate pain.”

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