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Podcast Transcript: The MOTION Study: Cryoablation for Painful Bone Metastases

with Dr. Jack Jennings

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology. You can read the full transcript below and listen to this episode here on BackTable.com.

(1) Introduction to the MOTION Study

(2) Indications, Benefits & Challenges of Cryoablation

(3) Key Results of the MOTION Study

(4) How to Choose the Right Cryoablation Probe

(5) Neuroprotection Techniques in Cryoablation

(6) Step-by-Step Guide to Setting Up Your Cryoablation Case

(7) Robotic Guidance Systems: The Future of Interventional Oncology

This podcast is supported by:

Boston Scientific Visual ICE Cryoablation System

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The MOTION Study: Cryoablation for Painful Bone Metastases with Dr. Jack Jennings on the BackTable MSK Podcast)

Ep 38 The MOTION Study: Cryoablation for Painful Bone Metastases with Dr. Jack Jennings

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[Dr. Jacob Fleming]
Hello, everyone. Welcome back to The Backtable MSK Podcast. This is your host, Jacob Fleming. Today, I'm back here with legendary interventional musculoskeletal radiologist, Jack Jennings. Dr. Jennings, always a pleasure. Thanks for coming back to the show.

[Dr. Jack Jennings]
Thank you for having me. Enjoy the conversation.

[Dr. Jacob Fleming]
Yes, always enjoy our conversation. I always appreciate you taking your time away from your extensive clinical duties, extracurricular duties, and small family of 9 to 15. Thank you, as always, for making the time. Today, I'm really looking forward to the conversation, talking to you about a field you have really helped push forward, which is cryoablation for bone mets. We discussed this a little bit last time on our episode on desmoids a little more than a year ago, but we're really going to focus in this time and talk about the results of the MOTION Study and the implications for this.

First of all, let's just jump in and tell a little bit about the MOTION Study, a brief intro about what was done, and then more generally, why cryoablation for bone mets. What was the impetus for looking at this? Give us a lowdown on the trial.

(1) Introduction to the MOTION Study

[Dr. Jack Jennings]
Got you. You asked me a lot of things here. I'll start with the overview. Matt Kohlstrom, Damien Dupuis, and a few of my other great colleagues did a prospective trial similar to this in 2013, maybe, was published in Cancer. Now you take it another eight years from there. Our goal was multifold. People are living longer. It's about 1.9 million people have cancer, diagnosed with cancer every year. People are living longer, and thus, they're getting bone metastasis.

One of our main goals was to increase broader adoption and knowledge of this and for pain palliation. It was really a simple prospective single-arm trial. It was international. I think we had four European sites, many out of France, looking at people with painful single bone metastasis and treating with cryoablation. We enrolled very similar to the mass trials in the '60s, like '66 or something like that. We took it out for six months. The primary objective was greater than two-point reduction of the pain score.

Then we looked at opioid use, quality of life, and like I said, carried it out for six months. The big impetus was also to just reinvigorate this more global, broader adoption of it because it's a need. You and I have talked about this multiple times. We just need to get more and more people doing this. Equally, to get the NCCN Guidelines and guidelines to promote this. As you've seen, we talked about this last time. We made a lot of leaps and jumps with it, come to NCCN Guidelines and ablation for pain palliation.

(2) Indications, Benefits & Challenges of Cryoablation

[Dr. Jack Jennings]
The other question said, why cryo? Cryo, we do a lot of in bone for many reasons. One, you can see the ice ball. Now, when I say that, when it's dense bone, you don't see within the bone, but you can see it extending beyond the bone. Two, it's a modality that we can sculpt. We can make geometries that you can't make necessarily with some of the heat-based thermal ablations. Typically, it's less painful.

Matt's group published that trial, RF versus cryo as far as pain from the procedure. Finally, where we are, I think we're going to talk about this, when we are close to nerves and other structures, they are much more forgiving with ice than they are with some of our heat-based modalities. That's a 30,000 foot overview of why cryo in bone.

[Dr. Jacob Fleming]
Absolutely. Thank you for that explanation. The MOTION Study really is very impressive. As you said, there's really the all-star cast. I was looking and thinking this is the Avengers of musculoskeletal interventional oncology. It's just a really impressive cast of clinicians who participated in this from all around the world. One of the things that really struck me was just how many different bone metastasis sites there were. There obviously were some recurrent ones, but this is quite different from some of the other studies that have focused more so on spine ablation.

In this study, the most common index tumor location was actually in the rib in about 24% of patients and a smattering of all over. One thing I wanted to touch on is bone mets, of course, can show up anywhere. There are places where they are more common, and some of these have their own consternation associated with them. For example, ribs can really be difficult in some ways. One thing I was curious about, not necessarily limited just to the trial, but your experience ablating a lot of these lesions, tell us about some of these recurrent sites such as rib or ilium and maybe some of the particular challenges that come up with those.

[Dr. Jack Jennings]
Yes. One caveat, one thing I will tell you. Spine is the number one site of metastatic disease, which I think you were alluding to. Cryo is done less in the spine for many reasons. A, you've got the spinal cord and nerves, and I call it the silent killer, meaning even under conscious sedation, you can take out a nerve in the spinal cord versus heat, much more thermotoxic and patients under conscious sedation will not allow you. If you look at all these spine metastatic trials, treating those with thermal ablation, radiofrequency ablation is number one hands down. In fact, that's the first modality that got us even ablating anything with osteoid osteomas.

This trial, very few spine, and there's a reason for that because it's not a great trial. Those are very complicated, and that goes to answering your question about how complicated. Now, so, pelvis is the number two site of metastasis. Not surprising that if you take sacrum, pelvis, ischium, all those in there, that would, I don't remember all the numbers, but they for sure add up to be number one. Ribs are very common. These chest wall, pleural base, lung, whether it's primary lung or metastatic lung, those are very common metastases and ones that we ablate.

We're also taking out the intercostal nerve. I believe you've had Prologo on here, given there's nerve spiel, for sure, my good friend up on the pulpit. You're really doing a double good thing. You're treating the met as you're taking out that intercostal nerve, which helps with that chest wall pain. If I were to give the most challenging, it's anywhere near a nerve. I do use cryo pretty consistently in the posterior elements of the spine, or when there's paraspinal soft tissue.

With those, I use evoke potentials, and I think we talked about that, your passive and active thermoprotective techniques, and then posterior acetabulum, the sciatics right there. That's another cautionary place. Really, those are the ones that I find the most challenging. Anybody can put a needle in any of these places, it's staying out of trouble, and that's what I find the most challenging.

Yes, I'm not surprised. We endorsed doing real-world stuff, and this is real-world stuff. One point I would make, and you can correct me on this because I don't have it in front of me, but it was a huge number of, it was close to 60% were greater than four centimeters. Big lesions. I think it was greater than four centimeters or more. It was two-thirds of them. That's real life. That's less than ideal because we would love to catch these before, but this is all part of getting this message out to our oncology colleagues and whatever.

These were real lesions. These weren't like chip shot, one, two-centimeter ditzels. These were big boys. If you've got it in front of you, I think greater than four centimeters is close to 60-some percent, right?

[Dr. Jacob Fleming]
Yes. The mean size is actually 5.7. Pretty impressive and with a large standard deviation, they have about 60% or more than four centimeters. These are serious metastatic lesions. I think the fact that it was skewed so far in that direction, and the patients really did quite well with this. Could you just briefly summarize for us again the results of this and how patients did, how this helped out?

(3) Key Results of the MOTION Study

[Dr. Jack Jennings]
Yes, so we used BPI, short-form worst pain, as the primary endpoint, and we showed durability because out to six months, patients had significant pain relief. Now with a 95% confidence interval, we picked eight weeks because we've done eight weeks for multiple other trials. You notice we just missed it by 0.2, whatever. I don't think that's the key. The key thing is, so we had a significant greater than two-point reduction all the way throughout, but if you take the 95th confidence interval, we were like minus 1.78, so just missed it at the eight weeks, but then everything after that was within the 95% confidence interval, which is what you want: durable, significant pain relief.

The graph goes like this and then all the way down and stays significant out to the six weeks. Then as we're looking at the morphine equivalent, there's very similar, the graphs. If you take pain and quality of life, they're both doing the same thing: significant decrease throughout the six-month interval, and that's the thing why I brought up the size. These were real lesions. With our trials, you want to be smart because you're trying to do the best.

You're not trying to, how do I say that, manipulate the trial, but there's people that are good study candidates and those who are not. You see here, these were big lesions, and I find with the bigger lesions. Now, we did do a univariate and multivariate analysis. The size did not impact whether those people were still at eight weeks or not. That being said, from my experience, the bigger lesions, it takes people some time to start feeling better. Anyway, so yes, if you look at all those three, the primary and secondary endpoints, they were significant throughout the six months.

[Dr. Jacob Fleming]
Absolutely. I think it's very impressive. As we know with these patients with bone metastatic lesions, they can really fall down the wrong path very quickly. It's always heartbreaking to me to see how a patient comes in who has been dealing with something for months and months and something that we really could have helped out sooner, but now they're on increasing doses of opioids, just trying to get it through the day and they're in a really tough spot. It always seems to me that the earlier we can get to handling these problems, the better. As you said, this is the real world. It's not always going to be on a silver platter at the tumor board, one centimeter solitary bone met. I think that's probably a much more rare situation than probably what was described in the study here.

[Dr. Jack Jennings]
I do think the good news is it's changing. We now are getting asked earlier on, and that is a testament, I believe, to what you guys are doing, what everybody's doing, Society of Interventional Oncology, SIR, everybody, name them all, CIRSE, just getting the message out, these podcasts, as I said, I think more and more people are doing it in these OBLs and not just at the "ivory towers". That's to me why I love what actually you all are doing and what everybody getting the message out. We are seeing much smaller lesions. I think we're making ground for sure.

[Dr. Jacob Fleming]
For sure. I've been really excited to hear about more and more people in the community setting who are starting to build up cryo programs and doing away with the notion, like you said, that this is just sort of an ivory tower practice. These patients are everywhere, and there have been a lot of people who have been successful setting up and taking care of these patients in their community, whether that's in an academic setting or somewhere more like a private practice setting. That's been really nice.

(4) How to Choose the Right Cryoablation Probe

[Dr. Jacob Fleming]
One thing in regards to the size of the lesions that this brings up, and you mentioned a moment ago, is the sculpting techniques with making your lesions. This is something I find really fascinating with cryo. Also from a planning standpoint, it definitely presents a bit of a cerebral challenge. I was just wondering, could you just tell us about your general approach with choosing the number and the type of probes that you're going to do? There are a lot of different kinds of probes, IceFORCE, Ice X, and so on and so forth. How do you go about choosing from the quiver what you're going to be using?

[Dr. Jack Jennings]
I'm an IceFORCE man, if you were going to talk Boston, it's a bigger gauge needle. The beauty is you can dial it down. 100% equals 100% of the time, the gases are either at 5,000, 3,000 PSI. Then if you dial it down, that's basically, okay, so 70% means 7 out of 10 seconds, it's on. You don't do percent gas, it doesn't work that way for the jewel tops. My point being is, except yesterday, I did a desmoid that was, people must think I only do desmoids, but I will tell you, it was six centimeters cranial-caudal by like two and a half centimeters.

I use the IcePearl. Again, it's a 2.1, so it's a bigger, and we did, I think it was a four-probe case, but I like the IceFORCE. I feel like with any of them, I can dial down, but I do use all of them. It's just nice and tougher tissue to use, that bigger gauge needle. That's the other beautiful thing with cryo is it covers a multitude of sins. You're a fellow. We got fellows, and there's nothing more than attendings love to blame everything on the fellows, but you got less than "ideal needle placement". I don't get too bent out of shape. Now you keep to some rules, the bigger ices can be about two centimeters away.

The smaller probes, meaning the smaller size ice balls, you want to be about 1.5 centimeters away and that's for both companies. That's a principle. As long as you stay with that, you'll see it. I'll go past the 10 minutes. They used to tell you at 10 minutes, it doesn't get bigger. That's a bunch of nonsense. I'll sometimes carry out the 15 minutes when you're seeing the ice ball grow and never had an issue with it. It's the visualization and knowing the planning is coverage, keeping those rules of the 2 or 20 millimeters, 15 millimeters distance, and just letting the ice work for you. It's very nice. It's not impedance-based. We don't have to worry about that. What you do have to worry about, it does blow through a cortex.

(5) Neuroprotection Techniques in Cryoablation

[Dr. Jacob Fleming]
Sure. One of the double-edged swords of the technique. Of course, you mentioned already something we talked about quite at length in our last discussion, which is these neuroprotective techniques. Just for folks who haven't listened to our prior episode, could you tell us just a little bit about the CO2 dissection and hydro dissection techniques that you do under CT?

[Dr. Jack Jennings]
Sure. I did it just yesterday. I saw the patient early this morning. She's doing well. This was a rectus abdominis lesion. Bowel is the issue there. If you're doing it as a vertebral body or posterior element, obviously it's the spinal cord and actually nerve roots. Then if you're in the pelvis, sciatic, femoral nerve, all those. We have passive thermal protection. What is that? That's where I'll bring out the evoke potentials, motor and somatosensory evoke potentials to look for dropout and decrease amplitude and increase-- They've got to give increased wattage to stimulate the nerve. We do that. That's passive.

We can put a thermocouple to measure temperatures. Then active is what you were alluding to in the sense of we can do hydrodissection. Yesterday, we used 0.5 mls of contrast per 10 mls of D5W and basically in the peritoneal cavity injecting. Then we did CO2. Now, the CO2 didn't go where I wanted it to. That's why you got to see what it's going to do. Basically with that contrast solution, we created, so the bowel was up against, she was not a real big person.

The bowel was up against the abdominal wall, and obviously you don't want to cryo that. We displaced it and you can see with the contrast. Then with the contrast, you can see the ice ball extending into that contrast so you know your gap. We do it for the skin as well. We do it epidural. I'll use contrast intrathecally like a myelogram. Then I can see the ice ball extending into the canal and also for displacement. As was the case yesterday, I spent longer doing that than putting down the probes, but you're not doing them a great favor.

You treat the lesion. Now, they come out with a new nerve injury. Those of us who've done this a lot have surely had that happen, not purposely. I pull out all the stops, and as CO2 in the spine, typically once you get above mid-thoracic because it goes up in the noggin, we don't like to use it. We use the hydro or cooling. With heat-based, I'll use D5W, slow push cooling in the epidural space. Then I use evoke potentials anywhere I'm worried about nerves, which obviously means they'll have to be under GA.

[Dr. Jacob Fleming]
For the actual needles, getting a little bit into the nitty gritty, the needles you use for a hydro dissection or a pneumo dissection, you're using like a 22 gauge, 18 gauge, 2E in the epidural space and just tell us a little bit about that.

[Dr. Jack Jennings]
Yes. If it's non-cryo, a 22 is just fine. For cryo, I use 18 gauge because they will freeze up because a lot of times your needles are close to where the ice fall, and that happened actually yesterday. We had a little plug we had to pop out because we were one of the 18 gauge is right there. Cryo, mostly 18 gauge spinal needles and then microwave or RF, I just use a 22 because it's easier, but I'm not worried about it freezing up, but you will see that with cryo. Just remember no saline with the RF because it creates a plasma field this year. Use that D5W when you're using RF, just to be safe.

[Dr. Jacob Fleming]
We don't need more plasma than necessary in our cases. Yes, so that's good.

[Dr. Jack Jennings]
Just your ablation zone gets a little not predictable, right?

(6) Step-by-Step Guide to Setting Up Your Cryoablation Case

[Dr. Jacob Fleming]
That's the issue with that. Got you. Talking about the imaging guidance on this case, I know you're a big CT proponent and using ultrasound as well in some cases here. Just tell us about your procedure suite for a typical cryoablation case for a MET case. What's sort of the setup like? Do you always have the ultrasound ready to go and patient that you alluded to usually being under sedation and just the setup the day of?

[Dr. Jack Jennings]
Depending on the case, longer cases, I pretty much will always do GA these days. Predominantly with cryo CT guidance so I can see or cone-beam CT, the problem is, well, you can see this is not as great a CT as my procedural CT. Ultrasound, I've got to make a decision. If I'm close to the skin and want to use ultrasound, then I can't use CO2 because obviously that's gas/CO2/air doesn't equal good ultrasound. Where I will use ultrasound over CO2 are in the extremities, some of these feet, whether it's neuromas or we had a sarcoma there recently where I'm getting really close to the skin.

Then I'll forego the CO2 and just do hydro dissection and then I put the ultrasound probe because then the hypoechoic ice ball going close to the skin. I'm a big proponent of not so much, not always in these cases, but for biopsy cases and all these, I've got the ultrasound in the CT room, like a proponent of doing both. Francois Cornelis, he will do some of these rib cryos with ultrasound, which I think is pretty cool. I don't, but Francois has some nice pictures of those. Surely ribs, if you're out on the fluffy side and you don't have a lot of ribs, ultrasound cryo for bone, so it's bone, would be just fine because he sets it right up next to the bone and also you can see the ice ball growing towards the skin.

Then in the room, you've got the electrophysiology people. It's a crowded room. Then you got the anesthesia people. Occasionally I can convince them to do MAC, which patients are always appreciative of, but the ones that are going to be three hours long, it's not unreasonable just to do GA. Then if they're obviously with evoked potentials, they can't paralyze them because you're evoking motor potentials, so A, they can't do the paralyzing.

Then, we don't have one yet, which we're going to in the new tower, the CT on rails or the combined hybrid, which maybe that's how we'll get our old friend Doug getting into 2023. We'll have to get one of those. That's having a sole fluoroscopic fellowship. There are benefits of both, and there's nothing. I was trained by Lou Galula, so I'm very fluoro-trained. I like comb beam. It's just comb beam to get those spins is not where-- there are newer units that are coming out for sure that are much better. That's where those hybrid units with the CT on rails offer the best of both worlds.

[Dr. Jacob Fleming]
Absolutely. I agree with that. I have a lot of envy for those systems, gotten to use a couple times, but I'll tell you there's nothing more frustrating than being ready to take a spin and then the machine starts telling you “does not compute, does not compute” because of the positioning or whatever.

[Dr. Jack Jennings]
It's hitting the drape, oh my gosh.

[Dr. Jacob Fleming]
I'm sure everyone listening to this has had that experience at some point. Again, cone-beam CT is super versatile, has so many uses. The hybrid angio-CT approach, I think it really works particularly well in a lot of these situations, especially in maybe some of the more complex ones where our vascular colleagues might be doing an embolization of like an RCC MET first. Of course, you really need that multimodality.

(7) Robotic Guidance Systems: The Future of Interventional Oncology

[Dr. Jacob Fleming]
One thing that has been coming out, as I'm sure you know, and I wanted to get your thoughts on is the notion of the robotic guidance systems. I think that's something that's really interesting in IO. I just wanted to hear what your thoughts were and have you had any experience trying out any of those systems?

[Dr. Jack Jennings]
Yes, so have not had experience but done a lot of talking with industry. I guess the first thing it is, it's our future, right? The younger neurosurgeons, especially those that are trained at Hopkins, are using robotics and augmented reality. It's the future. I think we, as radiologists, interventionists, have to stay with the future. This goes from robotics to all the image guidance, to all the pre-procedural planning, intra-procedural navigation, post-ablation confirmation, and robotics. I think the whole package we're going to see in the next decade be part of a lot of people's suites.

What I've seen as far as my stick with the bone and stuff, robotics isn't quite there because you got to get through some hard stuff. There are some limitations right now, but that's short-term. They're mostly geared towards soft tissue guidance right now. I think it's wicked cool. I'm getting to be the old man. It's easy to say, well, we just put the needle in and got there. We're at Mallinkrodt and this isn't a plug, kind of a Siemen's place, but there's some image guidance stuff on there.

Some of the younger faculty is like, I want to use it. I was like, "I don't know," and now guess who uses it? Just for not just the guidance as much, but for reasons like, I'll put it at the level of the spine, maybe they're counting issues. Then I don't have to keep recounting. I'm a big fan of it. Some of our Greek colleagues, Alexis Kelekis and Demetrius Filippiatis, they've been doing more and more with that as well. Fred Deschamps and Terry DeBert at their place, Gustav Ruzzi. It's our future. It'll be there. I'm also excited that our imaging partners are collaborating with this, whether you're GE, Siemens, Philips, they're getting more and more in this space. I'm super excited.

[Dr. Jacob Fleming]
Me too. I'm really excited to see where that'll be in the next five years. I think we're at the toe of the curve right now, maybe the early toe. I think we'll see some really interesting stuff. I find it super interesting as well because through LinkedIn or whatnot, I follow a bunch of different people. I see a lot of things from a spine surgery standpoint just because I'm very interested in that. They're embracing robotics in a lot of different areas right now that it's super interesting.

It's really the same goal, but then they come at it from a slightly different situation and using slightly different systems. Easy enough to say, okay, well, you can use navigation with an O-arm spin for putting in pedicle screws for a big fusion case. You can just do the same thing with IO, right? Then there's slightly different considerations. One of the things we've run into is we've started experimenting with this stuff for SI fusion cases.

There's something about just the lateral hammering on the ilium and the sacrum from lateral. Things just don't really stay in place. There's some little futzing around with that.
Tony Brown talked about this at one point that doing these complex IO cases under hybrid angio CT is, or even if you're just using the comb beam CT, sometimes the augmentation with the overlay with the flora will get knocked out of whack when you're vigorously trying to get a bone needle in place by hammering on stuff. There are certain things that we have to figure out and make sure that the navigation is right on because if the navigation is "only off by three millimeters", that three millimeters could make the difference between being in the sacral foramen and the sacral body.

[Dr. Jack Jennings]
Right, or in the canal. Just a plug for Tony Brown. He's the poster child for OBL out there. Tony really has shown what can be done out there. For all you out there who are in OBL, I'm offering him as a resource. Tony loves that. Tony has done great things, and he's a great example of how you can work with an orthopedic oncologist or orthopedist in an OBL and do some of this higher-end MSKIO. Anyway, that was purely off script. Tony, yes, for all you out there, Tony's a great role model for that.

[Dr. Jack Jennings]
Another plug that I'm on, this year at SIO, there's a new private practice on Monday for people who are in OBLs. Vijay's done a great job with this program. That's another push, these words. It really is. It's a great program for private practice people, and people like Tony are going to be there speaking. I think it'll be a wealth of knowledge. Jason Levy, another one. Sonny Bagla. These are all people out there that are doing stuff where it's not off script, meaning we do stuff that we're talking about today that can be helpful that, as I said, aren't in the "Ivory Towers, tertiary referral centers." Anyway, I don't know how you got me on that. I complete frontal release on you there. Anyway.

[Dr. Jacob Fleming]
No, that was perfect because I actually wanted to talk about that eventually. You predicted it and wanted to put in a plug for the upcoming SIO meeting, which will be in January. It's the 25th through the 29th. You mentioned the private practice symposium that's going to be on the last day of the conference. I think this is going to be something that's really excellent. I'm glad we mentioned Tony Brown as well because he is the example that I always use when I tell people about these things I'm really excited about.
Even from mostly people within our own specialty, they'll say, ah, well, there's no future for that outside of the ivory towers. It's like, look at this guy doing it. There are several others who have really done it well. Being able to take these techniques that seem arcane and esoteric and showing, yes, you can do it in an office-based lab with a comb beam CT, really powerful.

Of course, OBL is not the only situation. There's always going to be contexts in which you need to have the bigger hospital cases. You're not going to be doing a three-hour long GA case, obviously, in the OBL, but more and more of this stuff is it's becoming readily apparent that we can and we really need to scale this down and get it out into the community, just like we've ranted to each other about in the past.

[Dr. Jack Jennings]
Yes, I know. Todd just told me two days ago that Tony can do three of these screw fixation cases in a day. That tells you right there. I'm just saying, and I get it, Tony's been doing it, but that just shows you that everybody out there, this can be done and there's a lot more resources than there were a decade ago. You're going to see these people at that private practice symposium.

Another push, since we're talking about cryo, so it's not a stretch, there's a breast cryo ablation course. This is another, I don't know if you guys have done one of those, but it's a super hot topic. There's a lot of growth in this and treating these T1A lesions. Yes, there's a lot of exciting stuff for this SIO in Long Beach and Jacob's going to be there at the IO Essentials for you trainees out there. If you didn't get in this year, next year, it's just going to be a great meeting. I feel like every year, it just keeps building and getting better. Anyway, I'll stop my push. My plug.

[Dr. Jacob Fleming]
Perfect. I wanted to make sure we got into that and make sure that everyone knows that SIO is coming up. It's going to be an awesome meeting. Look forward to seeing everyone there, taking a selfie with Dr. Jennings himself. If you come up and see me, heckle me as well. We'll be there nerding out about all things cryo and otherwise interventional oncology. It'll be a great meeting and really looking forward to seeing the speed and the momentum and this continue to take off.

Dr. Jennings, that's all I have today. I think this was a great summary just about cryoablation in general and talking about the MOTION Study, arming our listeners with some knowledge to go out there and really start things up. Any final thoughts, anything else you wanted to discuss before we close up?

[Dr. Jack Jennings]
This is a plug out to all of our industry partners, the relationships we have, all of them. Some, I'm not going to name, but all these, just the relationships with the societies, that whole stigmata, conflict of interest, the walls have been broken down. This was an industry-sponsored trial, and just industry is we need each other. I just want to thank them all because we couldn't do what we do without them and relationships. You're going to see this, Jacob, as you're going. Well, you see with Doug, but just those relationships and we can advance because of them and vice versa. It's a shout out to all of them. Don't need to give individual names. You all know who you are, but thank you all for all you've done for us because it's super helpful.

[Dr. Jacob Fleming]
Agree completely. It's super helpful. It's a lot of fun collaborating with people who are just as invested in pushing things forward. Especially companies who are very receptive to the physician standpoint. A lot of the ones we work with in the IO world, they really defer to the expertise of the problems that interventional radiologists are coming up to on a daily basis and helping developing platforms that are better geared towards the problem at hand.

Just a quick tangent, a company that we've used some of their products for, this is more on a kyphoplasty side, but they've had just the other night, saw a new redone needle, just very simple kyphoplasty needle. This is the first one I've used that has a flat top on it. Flat top for being hit with a flat mallet, whereas you notice that most of them have a convex top. I always thought, why is that? That doesn't make any sense to me. Finally, some interventional radiologists, you can guess who said, "Hey, why don't we have two flat surfaces to hit together?" Then finally got that.

To have companies who will listen to that and say, "Yes, it's a good, why haven't we done that?" That's just a simple microcosm. I think that is generally how we work with, because with all the industry sponsors who are really involved in, for example, the IO stuff, those small incremental changes are what is going to make it possible to do the robotic guidance procedures in the OBL in 10 years. I agree with you completely, Dr. Jennings, and really appreciative of a lot of the work that those companies, as well as SIO, obviously we're all major fans here and looking forward to a really fantastic meeting in January.

Podcast Contributors

Dr. Jack Jennings

Dr. Jack Jennings is an inteventional radiologist with Washington University Physicians in St. Louis, Missouri.

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Cite This Podcast

BackTable, LLC (Producer). (2024, January 5). Ep. 38 – The MOTION Study: Cryoablation for Painful Bone Metastases [Audio podcast]. Retrieved from https://www.backtable.com

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