Radio-frequency ablation in bone lesions

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Many patients develop metastatic cancer in their bones from most cancer sites. We wanted to know if radiofrequency ablation (RFA) of bone lesions (i.e. secondary deposits in the bone) was: 1) effective in controlling symptoms 2) effective in controlling the disease within the bone

PICO terms

P: cancer patients I: radio-frequency ablation (RFA) to bone lesions C: in last 10 years O: RFA is either useful or not useful in controlling symptoms and cancer in bone 


Top papers identified

Title: Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation–a multicenter american college of radiology imaging network study.
Citation: Radiology, Sep 2013, vol. 268, no. 3, p. 907-915, 1527-1315 (September 2013)
Author(s): Guenette, Jeffrey P, Lopez, Michael J, Kim, Eunhee, Dupuy, Damian E
Abstract: To identify the correlation of pre- and postablation imaging features with pain relief, pain intensity, and patient mood after radiofrequency (RF) ablation of solitary painful osseous metastases. This prospective, multicenter group trial was approved by each institutional review board. Participants were enrolled between November 1, 2001, and April 6, 2006. Written informed consent was obtained from all subjects, and patient confidentiality protocols were followed in compliance with HIPAA. Computed tomography (CT)-guided RF ablation and contrast material-enhanced 1-month follow-up CT and/or magnetic resonance imaging were performed in 49 subjects (24 men, 25 women; age range, 34-83 years) with a confirmed malignant solitary bone lesion of maximum dimension of 8 cm or smaller that was causing intractable pain. Pain intensity and patient mood were measured before and after RF ablation. Tumor imaging features were recorded. Unadjusted and adjusted linear mixed-effects models, with a random intercept for each subject, were used to model patient mood, pain relief, and pain intensity scores at three times after ablation as a function of each tumor characteristic. Decreased postablation tumor pain correlated with preablation tumor volume (P = .02) and pathologic fracture (P = .01), while pain relief correlated with pathologic fracture (P = .03) and percentage of bone-tumor interface (BTI) ablated (P = .02). Conversely, presence of an irregular rim after ablation (P = .02) and rim thickness (P = .01) correlated with increased pain. There was no evidence in this study that RF ablation of larger tumor percentage or larger volume leads to better pain relief or decreased pain (P > .05). Existing pathologic fracture and smaller tumor size appear to be predictive parameters of success when selecting patients for palliative RF ablation of painful solitary osseous metastases. Successful palliation also appears to be related to the percentage of BTI ablated.

Title: Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients.
Citation: Skeletal radiology, Jan 2011, vol. 40, no. 1, p. 25-32, 1432-2161 (January 2011)
Author(s): Lane, Michael David, Le, Huy B Q, Lee, Steven, Young, Casey, Heran, Manraj K S, Badii, Maziar, Clarkson, Paul William, Munk, Peter L
Abstract: We report the safety and efficacy of combined radiofrequency ablation and cementoplasty in treating painful neoplastic bone lesions. Fifty-three combined radiofrequency ablation and cementoplasty procedures were completed in 36 patients. Thirty-four vertebrae (20 lumbar, 14 thoracic), 14 acetabulae, 3 sacra, 1 pubic symphysis, and 1 humerus were treated. Patient age ranged from 34 to 81 years (mean 57.6 years, SD=12.6). Primary malignancies included: 12 breast, 5 lung, 6 multiple myeloma, 2 prostate, 2 renal cell carcinoma, 1 synovial sarcoma, 1 endometrial, 1 oral squamous cell carcinoma, 1 lymphoma, 1 colon, 1 transitional cell carcinoma, 1 colorectal, 1 cholangiocarcinoma, and 1 pheochromocytoma. Primary neoplasm location, pain levels pre- and post-procedure (as assessed using the Visual Analog Scale), number of radiofrequency (RF) treatments and any extravasation were documented. Combined radiofrequency ablation (RFA) and cementoplasty procedures were performed with 100% technical success (53 out of 53). The mean pre-procedure and post-procedure pain, as measured by the Visual Analog Scale (VAS), was 7.2/10 and 3.4/10 respectively. Symptomatic complications included one case of self-resolving transient thermal sciatic neurapraxia following RFA and acetabuloplasty. Two cases of transient pain following epidural leaks during treatment of thoracic vertebrae and breast metastases also occurred. Non-symptomatic complications, from a variety of cases, included cement emboli to the lung, incidental, non-symptomatic leaks into the needle track, spinal canal, draining veins, disc spaces, and an intra-articular leak into the hip joint. Combined RFA and cementoplasty appears to be safe, practical and effective in the palliative treatment of painful neoplastic lesions.
Full Text:
Available from ProQuest in Skeletal Radiology
Available from EBSCOhost in Skeletal Radiology

Title: Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases.
Citation: Skeletal radiology, Jan 2013, vol. 42, no. 1, p. 25-36, 1432-2161 (January 2013)
Author(s): Clarençon, Frédéric, Jean, Betty, Pham, Hang-Phuong, Cormier, Evelyne, Bensimon, Gilbert, Rose, Michèle, Maksud, Philippe, Chiras, Jacques
Abstract: To evaluate the effectiveness of percutaneous radiofrequency (RF) ablation with or without percutaneous vertebroplasty (PV) on pain relief, functional recovery and local recurrence at 6 months’ follow-up (FU), in patients with painful osseous metastases. Thirty RF ablations were performed in 24 patients (mean age: 61 years) with bone metastases. Half of the patients had an additional PV. The primary end point was pain relief evaluated by a visual analogue scale (VAS) before treatment, and at 1 and 6 months’ FU. Functional outcome was assessed according to the evolution of their ability to walk at 6 months’ FU. Imaging FU was available in 20 out of 24 patients with a mean delay of 4.7 months. Reduction of pain was obtained at 6 months FU in 81% of cases (15 out of 18). Mean pretreatment VAS was 6.4 (±2.7). Mean VAS was 1.9 (±2.4) at 1 month FU, and 2.3 (±2.9) at 6 months’ FU. Pain was significantly reduced at 6 months FU (mean VAS reduction = 4.1; P < 0.00001). Functional improvement was obtained in 74% of the cases. Major complications rate was 12.5 % (3 out of 24) with 2 skin burns, and 1 case of myelopathy. Local tumour recurrence or progression was recorded in 5 cases. Radiofrequency ablation is an effective technique in terms of pain relief and functional recovery for the treatment of bone metastases, which provides a relatively low rate of local recurrence.
Full Text:
Available from ProQuest in Skeletal Radiology
Available from EBSCOhost in Skeletal Radiology

Title: Radiofrequency ablation of bone metastases induces long-lasting palliation in patients with untreatable cancer.
Citation: Singapore medical journal, Jul 2008, vol. 49, no. 7, p. 565-570, 0037-5675 (July 2008)
Author(s): Belfiore, G, Tedeschi, E, Ronza, F M, Belfiore, M P, Della Volpe, T, Zeppetella, G, Rotondo, A
Abstract: In oncological patients, life quality can be greatly impaired by the presence of painful bone metastases, as standard forms of treatment often achieve inadequate palliation. The aim of our study was to evaluate the clinical efficacy of radiofrequency ablation (RFA) with respect to pain relief in patients with refractory bone metastases or who are ineligible to conventional treatments. 12 patients with 13 painful osteolytic skeletal metastases, and who were unresponsive to analgesic drug therapy, underwent one (seven lesions) or two (five lesions) RFA sessions under computed tomography (CT) guidance. The RFA procedure was completed in all patients without complications. One patient also received cementoplasty after the RFA procedure. To obtain semiquantitative pain scores, the brief pain inventory (BPI) was administered before treatment and during follow-up. The local effects of RFA were monitored for at least one year in eight of 12 patients with CT and/or magnetic resonance imaging. Immediate pain relief after treatment was experienced by nine of 12 patients, but in two cases, pain recurred within the first week. Long-lasting palliation was obtained in seven of 12 patients. BPI mean scores for worst and average daily pain decreased from 7.7 and 5.0, respectively, at baseline, to 3.1 and 1.8, respectively, at one year. Imaging follow-up showed large areas of necrosis in nine of 12 lesions. In our preliminary experience, RFA showed good and long-lasting efficacy for pain control in bone metastases. A possible role of RFA as a coadjuvant palliative treatment in these cases is suggested.

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