Vertebral Metastasis
Conditions
Brief summary
The SPARTA study (Spinery® Radiofrequency Ablation Device Study) is a prospective, multicenter, single-arm clinical investigation designed to evaluate the safety, performance, and efficacy of the Spinery® RF Generator and its sterile single-use accessories for the palliative treatment of painful bone metastases. Adult patients with metastatic lesions involving the vertebral bodies, sacrum, iliac crest, or peri-acetabulum who were not candidates for, or had failed, standard therapies underwent percutaneous radiofrequency ablation with the investigational device. A total of 52 participants were enrolled across five Italian centers and were assessed at baseline, post-procedure, and during follow-up visits at 1, 3, and 12 months. Endpoints include evaluation of pain reduction, quality of life, usability, and procedural safety.
Detailed description
Bone metastases are a frequent cause of pain and disability in patients with advanced cancer, often leading to impaired mobility and reduced quality of life. Conventional treatments such as systemic analgesics, radiotherapy, or chemotherapy may not always achieve adequate symptom control, particularly in patients with recurrent or resistant disease. Radiofrequency (RF) ablation has emerged as a minimally invasive, image-guided procedure that induces controlled thermal necrosis within metastatic lesions, potentially reducing pain by interrupting nociceptive pathways and stabilizing the affected bone. The SPARTA study was designed to collect clinical data on the Spinery® RF Generator and its sterile single-use accessories, a bipolar/monopolar RF ablation technology intended for percutaneous use in bone metastases. This clinical investigation follows a prospective, multicenter, single-arm design without a control group; data are compared with published evidence available in the literature to contextualize safety and performance outcomes. A total of 52 patients were enrolled across five Italian centers. Eligible participants were adults with painful metastatic bone tumors located in the thoracic or lumbar vertebrae, sacrum, iliac crest, or peri-acetabulum. Following informed consent and baseline assessments, each patient underwent image-guided RF ablation using the Spinery® device. The procedure allowed the treating physician to select monopolar or bipolar cooled electrodes according to lesion size and location. Participants were monitored within 24 hours post-procedure and followed at 1, 3, and 12 months after treatment. Study assessments include: * Pain evaluation using the Brief Pain Inventory (BPI) * Quality of life assessment using the EQ-5D-5L questionnaire * Functional performance using the Karnofsky Performance Scale * Documentation of concomitant analgesic use and adverse events The primary objectives are: 1. To evaluate short-term pain reduction at 3 months following treatment, as measured by changes in the BPI worst pain score. 2. To evaluate procedural safety, defined as the percentage of procedures completed without device-related adverse events, including nerve injury. The secondary objectives are: * To assess long-term pain reduction at 12 months. * To evaluate usability and procedural performance (technical and procedural success without product-specialist intervention). * To monitor quality-of-life and functional outcomes over the follow-up period. This clinical investigation is conducted in compliance with ethical principles of Good Clinical Practice and applicable regulatory requirements.
Interventions
Radiofrequency ablation of bone metastases performed with the Spinery System, a radiofrequency generator with dedicated sterile, single-use accessories (electrode kit and cooling connection).
Sponsors
Study design
Intervention model description
Prospective, Multicenter, no control group
Eligibility
Inclusion criteria
* Patients with painful metastatic malignant lesions involving bone; * Patients, candidates to standard therapy, in which the RF ablation can be performed in combination with the Standard Therapy in accordance with the Investigator's indications; * Patients who have failed, not candidates or refuse Standard Therapy (chemotherapy or radiotherapy); * Patients with metastatic tumor size compatible with the expected ablation dimensions as reported for SPINERY devices in the IFU; * Patients with localized pain resulting from not more than two sites of symptomatic metastatic disease * Patients that do not have evidence of impending fracture * Patients with metastatic lesions targeted for treatment located in the thoracic and/or lumbar vertebral body(ies), peri-acetabulum, iliac crest, and/or sacrum - no restrictions on location of lesion; * Patients with BPI-Report worst pain score ≥4/10 at the target treatment site within the past 24 hours * Patients with Karnofsky score ≥ 40 at enrollment * Patients willing and able to provide a signed and dated informed consent, comply with the study plan, follow up visits and phone calls * Patients at least 18 years old at the time of informed consent
Exclusion criteria
* Patients implanted with heart pacemaker or other implanted electronic device * Patients with previous mechanical bone stabilization in the vertebral body to be treated * Use of SPINERY in vertebral body levels C1-C7 * Multiple myeloma, solitary plasmacytoma, or primary malignant lesions in the index vertebra or bone. * Active or incompletely treated local infection at the planned treatment site(s) and/or systemic infection. * Planned treatment site(s) accompanied by objective evidence of secondary radiculopathy or neurologic compromise. * Planned treatment site(s) associated with spinal cord compression or canal compromise requiring decompression. * Fractures due to prostatic cancer or other osteoblastic metastases to the spine. Metastatic lesions originating in the prostate that are osteolytic or of mixed origin are eligible for the study. * Pregnant, breastfeeding, or plan to become pregnant during the study duration. * Concurrent participation in another clinical study that may add additional safety risks and/or confound study results. * Any condition that would interfere with the subject's ability to comply with study instructions or might confound the study interpretation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Worst Pain and Quality of Life Scores at 3 Months Using the Brief Pain Inventory (BPI) and EQ-5D-5L Questionnaires | Baseline and 3-month follow-up | Pain severity and health-related quality of life were evaluated using two validated questionnaires: * Brief Pain Inventory (BPI): Participants rated their worst pain in the last 24 hours for each treated lesion site (thoracic, lumbar, peri-acetabulum, iliac crest, sacrum) on an 11-point numeric scale from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate worse pain. The change in BPI Worst Pain Score was calculated as the average reduction from baseline to the 3-month visit. * EQ-5D-5L: Participants reported their overall health status across five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each rated on five levels of severity. Responses were converted into a utility index ranging from -0.594 (worst health state) to 1.000 (best health state), where higher scores indicate better quality of life. The EQ-5D-5L visual analogue scale (VAS) ranges from 0 (worst imaginable health) to 100 (best imaginable health). |
| Number and Percentage of Participants Who Successfully Completed the Spinery® RF Ablation Procedure | Post-Procedure (primary evaluation point) | The number and percentage of participants who successfully completed the Spinery® RF ablation procedure per protocol. Completion is defined as participants who underwent the full planned treatment without premature discontinuation or technical interruption. Results are expressed as the count and percentage of the total number of treated participants. |
Countries
Italy
Participant flow
Recruitment details
Participants were recruited between July 2022 and Nov 2023 at 5 clinical sites. Eligible participants were adult who met all inclusion/exclusion criteria specified in the protocol. Recruitment followed standard informed consent procedures at each site.
Pre-assignment details
The Protocol Enrollment was 52 as planned. One participant withdrew consent after enrollment and prior to treatment allocation; therefore, 51 participants actually started the Spinery RF Ablation procedure. This explains the discrepancy between Protocol Enrollment and Started counts.
Participants by arm
| Arm | Count |
|---|---|
| BaseLine This single-arm group includes all patients enrolled and treated with the Spinery® RF Generator in combination with its sterile, single-use accessories (Spinery® Kit and Spinery® Cooling Connection). Each participant received radiofrequency (RF) ablation therapy targeted at bone metastatic lesions located in the vertebral bodies, sacrum, iliac crest, or peri-acetabulum. All procedures were image-guided and performed according to the protocol-defined treatment algorithm. Baseline demographic and clinical characteristics were collected before the ablation procedure and used to evaluate treatment efficacy and safety over time. | 51 |
| Total | 51 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| 12-Month Follow-up | Death | 8 |
| 12-Month Follow-up | Lost to Follow-up | 6 |
| 12-Month Follow-up | Withdrawal by Subject | 1 |
| 3-Month Follow-up | Death | 5 |
| 3-Month Follow-up | Lost to Follow-up | 4 |
| 3-Month Follow-up | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | BaseLine | — |
|---|---|---|
| Age, Categorical <=18 years | 0 Participants | — |
| Age, Categorical >=65 years | 27 Participants | — |
| Age, Categorical Between 18 and 65 years | 24 Participants | — |
| EQ-5D-5L | 42.8 units on a scale STANDARD_DEVIATION 16.8 | — |
| Pain Score at Baseline (BPI) | 7.8 units on a scale STANDARD_DEVIATION 1.6 | — |
| Primary Tumor Site Adeno Carcinoma | 1 participants | — |
| Primary Tumor Site Bladder | 1 participants | — |
| Primary Tumor Site Breast | 19 participants | — |
| Primary Tumor Site Chest | 1 participants | — |
| Primary Tumor Site Colon | 1 participants | — |
| Primary Tumor Site Intestine | 1 participants | — |
| Primary Tumor Site Kidney | 4 participants | — |
| Primary Tumor Site Liver | 1 participants | — |
| Primary Tumor Site Lungs | 12 participants | — |
| Primary Tumor Site Lymphomas | 1 participants | — |
| Primary Tumor Site Lynphatic system | 1 participants | — |
| Primary Tumor Site Other | 1 participants | — |
| Primary Tumor Site Pancreas | 1 participants | — |
| Primary Tumor Site Prostate | 4 participants | — |
| Primary Tumor Site Sarcoma | 1 participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 31 Participants | — |
| Sex: Female, Male Male | 20 Participants | — |
| Target Lesion Location Iliac Crest | 7 Participants | — |
| Target Lesion Location Pari-acetabulum | 7 Participants | — |
| Target Lesion Location Sacrum | 10 Participants | — |
| Target Lesion Location Vertebral Body | 27 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 13 / 51 |
| other Total, other adverse events | 1 / 51 |
| serious Total, serious adverse events | 13 / 51 |
Outcome results
Change From Baseline in Worst Pain and Quality of Life Scores at 3 Months Using the Brief Pain Inventory (BPI) and EQ-5D-5L Questionnaires
Pain severity and health-related quality of life were evaluated using two validated questionnaires: * Brief Pain Inventory (BPI): Participants rated their worst pain in the last 24 hours for each treated lesion site (thoracic, lumbar, peri-acetabulum, iliac crest, sacrum) on an 11-point numeric scale from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate worse pain. The change in BPI Worst Pain Score was calculated as the average reduction from baseline to the 3-month visit. * EQ-5D-5L: Participants reported their overall health status across five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each rated on five levels of severity. Responses were converted into a utility index ranging from -0.594 (worst health state) to 1.000 (best health state), where higher scores indicate better quality of life. The EQ-5D-5L visual analogue scale (VAS) ranges from 0 (worst imaginable health) to 100 (best imaginable health).
Time frame: Baseline and 3-month follow-up
Population: All participants who started treatment and completed the 3-month follow-up visit are included in this analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 3-Months Follow-up | Change From Baseline in Worst Pain and Quality of Life Scores at 3 Months Using the Brief Pain Inventory (BPI) and EQ-5D-5L Questionnaires | Change in Worst Pain Score (BPI, 0-10 scale; higher = worse pain) | 3.4 points on a numeric scale | Standard Deviation 2.8 |
| 3-Months Follow-up | Change From Baseline in Worst Pain and Quality of Life Scores at 3 Months Using the Brief Pain Inventory (BPI) and EQ-5D-5L Questionnaires | Change in Quality of Life (EQ-5D-5L VAS, 0-100 scale; higher = better health status) | 65.2 points on a numeric scale | Standard Deviation 19 |
Number and Percentage of Participants Who Successfully Completed the Spinery® RF Ablation Procedure
The number and percentage of participants who successfully completed the Spinery® RF ablation procedure per protocol. Completion is defined as participants who underwent the full planned treatment without premature discontinuation or technical interruption. Results are expressed as the count and percentage of the total number of treated participants.
Time frame: Post-Procedure (primary evaluation point)
Population: All participants who started treatment and were evaluated for procedural completion.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 3-Months Follow-up | Number and Percentage of Participants Who Successfully Completed the Spinery® RF Ablation Procedure | 51 Participants |