Clinical study
Radiofrequency Ablation in Combination with Osteoplasty in the Treatment of Painful Metastatic Bone Disease

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Purpose

To evaluate the feasibility and effectiveness of combining radiofrequency (RF) ablation and osteoplasty for pain reduction in the treatment of painful osteolytic metastases.

Materials and Methods

Within 5 years, 22 patients (15 men and seven women; median age, 64 years) with 28 lesions located in the thoracic and lumbar spine, sacrum, pelvis, acetabulum, femur, and tibia were treated. Underlying tumors were breast, lung, renal cell, thyroid, cancer of unknown primary, and multiple myeloma. RF ablation was performed with the patient under moderate sedation and computed tomographic fluoroscopy guidance and was immediately followed by cement injection. Pain relief was evaluated with the visual analogue scale (VAS) score and the extent to which analgesics could be reduced. Clinical success was defined as a substantial reduction in pain and/or a reduced demand for analgesics, and technical success was defined as distribution of cement between both endplates of a vertebral body or at least 75% filling of osteolyses in other bones.

Results

Technical success and pain relief was achieved in all patients. Pain ratings with the VAS decreased from a mean of 8.5 to a mean of 5.5 after 24 hours (P < .01), and a further decrease was detected after 3 months to 3.5 (P < .01). The amount or strength of analgesics was reduced in 15 patients and remained unchanged in five. In two patients, the amount of analgesics increased due to tumor progression elsewhere. No major complication, no clinically obvious fracture of a formerly treated bone or treatment-related death, occurred.

Conclusions

RF ablation and osteoplasty can be combined within one session and is both feasible and useful for the treatment of osteolytic bone metastases with regard to pain relief.

Section snippets

Patients

At least 24 hours before undergoing the treatment, all patients or their legal guardians gave written informed consent after receiving an explanation of the planned therapeutic intervention, alternative therapeutical options, and possible complications. All patients were treated according to the recommendations of the local tumor board. The approval of the local institutional review board was not necessary due to the character of the study as a retrospective analysis of formerly treated

Results

In all patients, RF ablation was possible in terms of complete ablation of the targeted tumor volume. The subsequent vertebro- and osteoplasties, respectively, were also successful in all patients in terms of filling of the targeted lesion. In all patients, moderate sedation was sufficient and no single treatment had to be aborted due to pain or incompliance of the patients. No major complication occurred in this patient collective. In eight of the 14 patients with metastases of vertebral

Discussion

Depending on the underlying metastatic disease, osteolytic metastases occur in up to 70% of patients (1), and more than 50% of those patients develop intractable pain during the course of their disease (2). Surgery, chemotherapy, and analgesics, as well as radiation therapy, are the standard treatments in patients with bone destructions due to skeletal metastases. With radiation therapy, partial or complete pain relief can be achieved within 10–14 days after the beginning of the radiation

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    None of the authors have identified a conflict of interest.

    Drs. RT Hoffmann and TF Jakobs contributed equally to this paper.

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    Copyright © 2008 SIR. Published by Elsevier Inc. All rights reserved.