Abstract
Objective
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.
Materials and methods
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.
Results
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.
Conclusion
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.
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Abbreviations
- FU:
-
Follow-up
- RF:
-
Radiofrequency
- SUV:
-
Standardised uptake value
- VAS:
-
Visual analogue scale
References
Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317:18–21.
Berrettoni BA, Carter JR. Mechanisms of cancer metastasis to bone. J Bone Joint Surg Am. 1986;68:308–12.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.
Dorrepaal KL, Aaronson NK, van Dam FS. Pain experience and pain management among hospitalized cancer patients. A clinical study. Cancer. 1989;63:593–8.
Solbiati L, Livraghi T, Goldberg SN, et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology. 2001;221:159–66.
Lanuti M, Sharma A, Digumarthy SR, et al. Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:160–6.
Mayo-Smith WW, Dupuy DE. Adrenal neoplasms: CT-guided radiofrequency ablation—preliminary results. Radiology. 2004;231:225–30.
Woertler K, Vestring T, Boettner F, Winkelmann W, Heindel W, Lindner N. Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients. J Vasc Interv Radiol. 2001;12:717–22.
Nakatsuka A, Yamakado K, Maeda M, et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol. 2004;15:707–12.
Hoffmann RT, Jakobs TF, Trumm C, Weber C, Helmberger TK, Reiser MF. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. J Vasc Interv Radiol. 2008;19:419–25.
Belfiore G, Tedeschi E, Ronza FM, et al. Radiofrequency ablation of bone metastases induces long-lasting palliation in patients with untreatable cancer. Singapore Med J. 2008;49:565–70.
Quinart A, Nouette-Gaulain K, Pfeiff R, Revel P, Sztark F. Target-controlled infusion of propofol for intraoperative sedation: determination of effect-site concentration and assessment of bispectral index. Ann Fr Anesth Reanim. 2004;23:675–80.
Cancer pain relief and palliative care: report of a WHO expert committee. Geneva: World Health Organization, 1996.
Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22:300–6.
Callstrom MR, Charboneau JW, Goetz MP, et al. Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation. Radiology. 2002;224:87–97.
Gronemeyer DH, Schirp S, Gevargez A. Image-guided radiofrequency ablation of spinal tumors: preliminary experience with an expandable array electrode. Cancer J. 2002;8:33–9.
Van der Linden E, Kroft LJ, Dijkstra PD. Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients. J Vasc Interv Radiol. 2007;18:741–7.
Carrafiello G, Lagana D, Pellegrino C, et al. Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience. Radiol Med. 2009;114:608–25.
Dupuy DE, Liu D, Hartfeil D et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 116:989–997.
Kojima H, Tanigawa N, Kariya S, Komemushi A, Shomura Y, Sawada S. Clinical assessment of percutaneous radiofrequency ablation for painful metastatic bone tumors. Cardiovasc Intervent Radiol. 2006;29:1022–6.
Thanos L, Mylona S, Galani P, et al. Radiofrequency ablation of osseous metastases for the palliation of pain. Skeletal Radiol. 2008;37:189–94.
Toyota N, Naito A, Kakizawa H, et al. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol. 2005;28:578–83.
Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350:1655–64.
Dierckx R, Maes A, Peeters M, Van De Wiele C. FDG PET for monitoring response to local and locoregional therapy in HCC and liver metastases. Q J Nucl Med Mol Imaging. 2009;53:336–42.
Barker DW, Zagoria RJ, Morton KA, Kavanagh PV, Shen P. Evaluation of liver metastases after radiofrequency ablation: utility of 18F-FDG PET and PET/CT. AJR Am J Roentgenol. 2005;184:1096–102.
McGahan JP, Khatri VP. Imaging findings after liver resection by using radiofrequency parenchymal coagulation devices: initial experiences. Radiology. 2008;247:896–902.
Nour SG, Aschoff AJ, Mitchell IC, Emancipator SN, Duerk JL, Lewin JS. MR imaging-guided radio-frequency thermal ablation of the lumbar vertebrae in porcine models. Radiology. 2002;224:452–62.
Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD. Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics. 2007;27:173–87.
Rowland IJ, Rivens I, Chen L, et al. MRI study of hepatic tumours following high intensity focused ultrasound surgery. Br J Radiol. 1997;70:144–53.
Ohira T, Okuma T, Matsuoka T, et al. FDG-MicroPET and diffusion-weighted MR image evaluation of early changes after radiofrequency ablation in implanted VX2 tumors in rabbits. Cardiovasc Intervent Radiol. 2009;32:114–20.
Steinke K, Gananadha S, King J, Zhao J, Morris DL. Dispersive pad site burns with modern radiofrequency ablation equipment. Surg Laparosc Endosc Percutan Tech. 2003;13:366–71.
Giorgio A, Tarantino L, de Stefano G, Coppola C, Ferraioli G. Complications after percutaneous saline-enhanced radiofrequency ablation of liver tumors: 3-year experience with 336 patients at a single center. AJR Am J Roentgenol. 2005;184:207–11.
Netherton BL, Stecker MM, Patterson T. Mechanisms of electrode induced injury. III. Practical concepts and avoidance. Am J Electroneurodiagnostic Technol. 2007;47:257–63.
Yamane T, Tateishi A, Cho S, et al. The effects of hyperthermia on the spinal cord. Spine (Phila Pa 1976). 1992;17:1386–91.
Letcher FS, Goldring S. The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg. 1968;29:42–7.
Adachi A, Kaminou T, Ogawa T, et al. Heat distribution in the spinal canal during radiofrequency ablation for vertebral lesions: study in swine. Radiology. 2008;247:374–80.
Gangi A, Basile A, Buy X, Alizadeh H, Sauer B, Bierry G. Radiofrequency and laser ablation of spinal lesions. Semin Ultrasound CT MR. 2005;26:89–97.
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The authors thank M. Pierre Grare for his kind help in the English editing of the manuscript.
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Clarençon, F., Jean, B., Pham, HP. et al. Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases. Skeletal Radiol 42, 25–36 (2013). https://doi.org/10.1007/s00256-011-1294-0
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DOI: https://doi.org/10.1007/s00256-011-1294-0