Ablation treatment of bone metastases

• US 20030040743A1
• Filed: 09/27/2002
• Published: 02/27/2003
• Est. Priority Date: 06/11/1999
• Status: Active Grant

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Sherwood Services AG
• Inventors: Cosman, Eric R., Rittman, William
• Granted Patent: US 6,881,214 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 2017/00694 with means correcting for movement of or for synchronisation with the body
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00208 actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/1861 with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems

Abstract

Ablative treatment of metastatic bone tumors and relief of pain associated with metastatic bone tumors is achieved by heat ablation of the bone tumor or tissue near the bone tumor by an ablation probe. In one form the probe is an electrode coupled to a high frequency power supply to provide ablative heating of tissue proximate to an electrode that is placed in or near the bone tumor. Cooling of the electrode by fluid circulation from a cooling apparatus outside the patient'"'"'s body may be used to enlarge the region of high frequency heating around the electrode. Image guidance of the electrode placement may be monitored by an imaging device. Tracking of the electrode by an image-guided navigator helps in placement of the electrode with respect to the configuration of the bone and bone metastasis. A set of tools accommodates biopsy and various shapes of electrodes according to clinical requirements. Several forms of electrodes, energy delivery and cooling apparatus and methods accommodate the specific objectives.

Claims

1. A method of treating a cancerous bone tumor or pain associated with a cancerous bone tumor in the body of a patient, comprising:

inserting at least one probe into the cancerous bone tumor or tissue proximate to said cancerous bone tumor, the at least one probe being adapted to be connected to external apparatus external to the patient'"'"'s body which can deliver power through the at least one probe to tissue within or near the cancerous bone tumor; and

applying power from the external apparatus to the tissue near or within the cancerous bone tumor through the at least one probe, causing heating of the tissue near or within the cancerous bone tumor to ablate at least a portion of the tissue near or within the bone tumor or to relieve pain associated with the cancerous bone tumor.

2. The method of claim 1 wherein the at least one probe includes a high frequency applicator and the external apparatus is a high frequency generator, the method further including the step of applying the high frequency power output of the high frequency generator through the high frequency applicator to deposit high frequency energy into the tissue near or within the cancerous bone tumor, thereby heating the tissue.

3. The method of claim 1 wherein the at least one probe comprises a resistive heater element and the external apparatus is a source of electrical power, the method further including the step of delivering the electrical power from the external apparatus to the resistive heater element to cause heating of the tissue near or within the cancerous bone tumor.

4. The method of claim 1 wherein the at least one probe and the external apparatus comprise a cooling system, the method further including the step of cooling the tissue while applying the power from the external apparatus to provide an enlarged region of heat ablation of the tissue.

5. The method of claim 4 wherein the cooling system comprises a conduit for cooling fluid that is supplied by the external apparatus through the at least one probe to cool a portion of the at least one probe and thereby to cool the tissue near or within the bone tumor, the method further including the step of circulating of the cooling fluid through the at least one probe to cool the tissue while applying the power from the external apparatus.

6. The method of claim 1 wherein the at least one probe is directed by an image-guided navigator that provides a representation of the position of the at least one probe with respect to the tissue based on imaging data representative of the tissue, the method further including the step of placing the at least one probe into the tissue while controlling the position of the at least one probe with respect to the tissue as represented by the image-guided navigator.

7. The method of claim 1 wherein the step of inserting at least one probe is directed in part by image representations from an imaging machine that monitors the position of the at least one probe with respect to at least one of the group comprising the body of a patient, the tissue near the cancerous bone tumor and the tissue within the cancerous bone tumor, the method further including the step of developing the image representations while performing the step of inserting at least one probe.

8. The method of claim 1 wherein the at least one probe is adapted to be used with an insertion tool and biopsy device through a common insertion tract into the cancerous bone tumor, the method further including the step of inserting the insertion tool and the biopsy tool into the cancerous bone tumor or tissue near the cancerous bone tumor prior to the inserting of the at least one probe.

9. A system for treating a cancerous bone tumor or pain associated with a cancerous bone tumor in the body of a patient, comprising:

a cannula adapted to be inserted into the cancerous bone tumor;

a probe adapted to be passed through the cannula into the cancerous bone tumor or tissue nearby to the cancerous bone tumor, the probe adapted to be connected to an external apparatus external to the body of the patient which can deliver power through the probe to heat at least a portion of the cancerous bone tumor; and

a connection from the probe to the external apparatus to deliver the power from the external apparatus through the probe.

10. The system of claim 9 wherein the cannula comprises a tubing and a stylet with a pointed distal tip for insertion into the cancerous bone tumor, wherein the probe is a high frequency electrode adapted to be inserted into the tubing when the stylet is removed, the high frequency electrode having an exposed conductive tip that can emerge from a distal end opening of the tubing to be located near to the cancerous bone tumor, wherein the external apparatus is a high frequency generator that supplies high frequency output through the exposed conductive tip via the connection to produce heating of at least a portion of the cancerous bone tumor or tissue near the cancerous bone tumor.

11. The system of claim 10 and further including a biopsy device adapted to be passed through the tubing when the stylet is removed so that a biopsy of the cancerous bone tumor can be taken prior to insertion of the high frequency electrode into the tubing.

12. The system of claim 9 wherein the probe comprises a resistive heating element and the external apparatus comprises a power source to supply current to the resistive heating element through the connection.

13. The system of claim 10 wherein the exposed conductive tip comprises a straight portion that emerges from the distal end opening of the tubing in a direction substantially parallel to the direction of the tubing.

14. The system of claim 10 wherein the exposed conductive tip comprises a curvable portion that is adapted to emerge from the distal end opening of the tubing along a curved path.

15. The system of claim 10 wherein the external apparatus comprises a cooling system with a cooling connection to the high frequency electrode for delivery of cooling fluid to the high frequency electrode, the high frequency electrode comprising an internal channel for the cooling fluid so that at least a portion of the exposed conductive tip can be cooled by the cooling fluid delivered by the cooling system with resultant cooling of tissue near the exposed conductive tip while the high frequency output is heating the at least a portion of the cancerous bone tumor or tissue near the cancerous bone tumor.