Skeletal Radiology

, Volume 40, Issue 1, pp 25–32 | Cite as

Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients

  • Michael David Lane
  • Huy B. Q. Le
  • Steven Lee
  • Casey Young
  • Manraj K. S. Heran
  • Maziar Badii
  • Paul William Clarkson
  • Peter L. Munk
Scientific Article



We report the safety and efficacy of combined radiofrequency ablation and cementoplasty in treating painful neoplastic bone lesions.

Materials and Methods

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.


Painful bone metastasis Radiofrequency ablation Cementoplasty Palliative care 


Conflict of interest



  1. 1.
    Husband DJ. Malignant spinal compression: prospective study of delays in referral and treatment. BMJ. 1998;337:18–21.Google Scholar
  2. 2.
    Doepaal KL, Aaronson NK, van Dam FS. Pain experience and pain management amongst hospitalized cancer patients: a clinical study. Cancer. 1989;63:593–8.CrossRefGoogle Scholar
  3. 3.
    Basile A, Giuliano G, Scuderi V. Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med. 2008;113:1018–28.CrossRefPubMedGoogle Scholar
  4. 4.
    Gangi A, Kastler B, Klinkert A, Dietemann JL. Injection of alcohol into bone metastases under CT guidance. J Comput Assist Tomogr. 1994;18:932–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Gröenemeyer DH, Schirp S, Gevargez A. Image-guided percutaneous thermal ablation of bone tumors. Acad Radiol. 2002;9:467–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Simon CJ, Dupuy DE, William W. Microwave ablation: principles and applications. Radiographics. 2005;25:69–83.CrossRefGoogle Scholar
  7. 7.
    Callstrom MR, Atwell TD, Charboneau W, et al. Painful metastases involving bone: percutaneous image-guided cryoablation—prospective trial interim analysis. Radiology. 2006;241:572–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Masala S, Schillaci O, Bartolucci AD, Calabria F, Mammucari M, Simonetti G. Metabolic and clinical assessment of efficacy of cryoablation therapy on skeletal masses by 18F-FDG positron emission tomography/computed tomography (PET/CT) and visual analogue scale (VAS): initial experience. Skeletal Radiol. 2010; doi: 10.1007/s00256-010-0960-y.PubMedGoogle Scholar
  9. 9.
    Tuncali K, Morrison PR, Winalski CS, et al. MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience. AJR Am J Roentgenol. 2007;189:232–9.CrossRefGoogle Scholar
  10. 10.
    Callstrom MR, Jurup AN. Percutaneous ablation for bone and soft tissue metastaseswhy cryoablation? Skeletal Radiol. 2009;38:835–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Rosenthal DI, Springfield DS, Gebhardt MC, et al. Osteoid osteoma: percutaneous radio-frequency ablation. Radiology. 1995;197:451–4.PubMedGoogle Scholar
  12. 12.
    Rosenthal DR, Hornicek FJ, Wolfe MW, et al. Percutaneous radiofrequency coagulation of osteoid osteomas compared with operative treatment. J Bone Joint Surg Am. 1998;80:815–21.PubMedGoogle Scholar
  13. 13.
    Callstrom MR, Charboneau JW, Goetz MP, et al. Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radiofrequency ablation. Radiology. 2002;224:87–97.CrossRefPubMedGoogle Scholar
  14. 14.
    Buy X, Basile A, Bierry G, Cupelli J, Gangi A. Saline-infused bipolar radiofrequency ablation of high-risk spinal and paraspinal neoplasms. AJR Am J Roentgenol. 2006;86:S322–6.CrossRefGoogle Scholar
  15. 15.
    Gronemeyer DHW, Schirp S, Gevargez A. Image-guided radiofrequency ablation of spinal tumors: preliminary experience with an expandable array electrode. Cancer J. 2002;8:33–9.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques and diagnostic imaging guidance. AJR Am J Roentgenol. 2000;174:189–94.Google Scholar
  18. 18.
    Thanos L, Mylona S, Galani P, et al. Radiofrequency ablation of osseous metastases for the palliation of pain. Skeletal Radiol. 2008;37:189–94.CrossRefPubMedGoogle Scholar
  19. 19.
    Toyota N, Naito A, Kakizawa H, et al. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cadiovasc Intervent Radiol. 2005;28:578–83.CrossRefGoogle Scholar
  20. 20.
    Nakatuska 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(15):707–12.Google Scholar
  21. 21.
    Van der Linden E, Kroft LJM, Dijkstra PDS. 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;18:741–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Halpin RJ, Bendok BR, Sat KT, Liu JC, Patel JD, Rosen ST. Combination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report. Surg Neurol. 2005;63:469–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Schaefer O, Lohrmann C, Herling M, Uhrmeister P, Langer M. Combined radiofrequency thermal ablation and percutaneous cementoplasty treatment of a pathological fracture. J Vasc Interv Radiol. 2002;13:1047–50.CrossRefPubMedGoogle Scholar
  24. 24.
    Hoffman RT, Jakobs T, Trumm C, Weber C, Helmberger TK, Reiser M. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone diseases. J Vas Interv Radiol. 2008;19:419–25.CrossRefGoogle Scholar
  25. 25.
    Georgy BA. Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions. AJNR Am J Neuroradiol. 2009;30:1197–202.CrossRefPubMedGoogle Scholar
  26. 26.
    Munk PL, Rashid F, Heran MK, Papirny M, et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol. 2009;7:903–11.CrossRefGoogle Scholar
  27. 27.
    Woolf CJ, Allchorne A, Safieh-Garabedian B, Poole S. Cytokines, nerve growth factor and inflammatory hyperalgesia: the contribution of tumor necrosis factor alpha. Br J Pharmacol. 1997;121:417–24.CrossRefPubMedGoogle Scholar
  28. 28.
    Heran RJ, Legiehn GM, Munk PL. Current concepts and techniques in percutaneous vertebroplasty. Orthop Clin North Am. 2006;37:409–34.CrossRefPubMedGoogle Scholar
  29. 29.
    Kim YJ, Lee JW, Park KW, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology. 2009;251:250–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–79.CrossRefPubMedGoogle Scholar
  31. 31.
    Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–68.CrossRefPubMedGoogle Scholar
  32. 32.
    Baerlocher MO, Munk PL, Liu DM. Letter to the editor. N Engl J Med. 2009;361:2098.PubMedGoogle Scholar
  33. 33.
    Munk PL, Liu DM, Murphy KP, Baerlocher MO. Effectiveness of vertebroplasty: a recent controversy. Can Assoc Radiol J. 2009;60:170–1.CrossRefPubMedGoogle Scholar
  34. 34.
    Baerlocher MO, Munk PL, Radvany MG, Murphy TP, Murphy KJM. Vertebroplasty, research design, and critical analysis. J Vasc Interv Radiol. 2009;20:1277–8.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • Michael David Lane
    • 1
  • Huy B. Q. Le
    • 1
  • Steven Lee
    • 1
  • Casey Young
    • 1
  • Manraj K. S. Heran
    • 1
  • Maziar Badii
    • 2
  • Paul William Clarkson
    • 3
  • Peter L. Munk
    • 1
  1. 1.Department of Radiology, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Internal Medicine, Division of Rheumatology, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  3. 3.Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada

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