Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience
- 481 Downloads
The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease.
This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome—including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points.
Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure.
CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease.
KeywordsPercutaneous Cryoablation Musculoskeletal Intervention
Conflict of interest
The primary author of this manuscript has consulted on behalf of Galil in the past (2012).
Have provided paid consultation in the past for Galil Medical.
- 3.Jimenez Andrade JM, Mantyh P. Cancer Pain: From the Development of Mouse Models to Human Clinical Trials. In: Kruger L, Light AR, editors. Translational Pain Research: From Mouse to Man. Frontiers in Neuroscience. Boca Raton, FL2010.Google Scholar
- 23.Thacker PG, Callstrom MR, Curry TB, Mandrekar JN, Atwell TD, Goetz MP, et al. Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients’ immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol. 2011;197(2):510–5.PubMedCrossRefGoogle Scholar
- 26.Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: Multicenter trial. Cancer. 2012 Oct 12Google Scholar
- 27.Masala S, Chiocchi M, Taglieri A, Bindi A, Nezzo M, De Vivo D, et al. Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty. Neuroradiology. 2012 Sep 27Google Scholar
- 29.McMenomy BP, Kurup AN, Johnson GB, Carter RE, McWilliams RR, Markovic SN, et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. Journal of vascular and interventional radiology:JVIR. 2012 Dec 19Google Scholar
- 30.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 18 F-FDG positron emission tomography/computed tomography (PET/CT) and visual analogue scale (VAS): initial experience. Skelet Radiol. 2011;40(2):159–65.CrossRefGoogle Scholar
- 37.Mani A SC. Bone Metastases. In: Walsh, TD, editor. Walsh: Palliative Medicine. 1st ed. Philadelphia: Saunders; 2009.Google Scholar
- 42.Ingunn HC, Robert E. Bone Metastases. Abeloff’s clinical oncology. 4th ed. Philadelphia: Churchill Livingstone/Elsevier; 2008. p. 845–71.Google Scholar
- 43.Fairchild A CE. Palliative Radiation Therapy. In: Walsh, TD, editor. Walsh: Palliative Medicine. 1st ed. Philadelphia: Saunders; 2009.Google Scholar
- 45.Choi J, Raghavan M. Diagnostic imaging and image-guided therapy of skeletal metastases. Cancer Control: J Moffitt Cancer Cent. 2012;19(2):102–12.Google Scholar
- 56.Erinjeri JP, Thomas CT, Samoilia A, Fleisher M, Gonen M, Sofocleous CT, et al. Image-guided thermal ablation of tumors increases the plasma level of interleukin-6 and interleukin-10. Journal of vascular and interventional radiology: JVIR. 2013 Apr 9Google Scholar
- 58.Bang HJ, Littrup PJ, Goodrich DJ, Currier BP, Aoun HD, Heilbrun LK, et al. Percutaneous cryoablation of metastatic renal cell carcinoma for local tumor control: feasibility, outcomes, and estimated cost-effectiveness for palliation. J Vasc Interv Radiol: JVIR. 2012;23(6):770–7.PubMedCrossRefGoogle Scholar