Skeletal Radiology

, Volume 43, Issue 11, pp 1551–1559 | Cite as

Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

  • J. David Prologo
  • Matthew Passalacqua
  • Indravadan Patel
  • Nathan Bohnert
  • David J. Corn
Scientific Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease.

Keywords

Percutaneous Cryoablation Musculoskeletal Intervention 

Notes

Conflict of interest

The primary author of this manuscript has consulted on behalf of Galil in the past (2012).

Disclosure

Have provided paid consultation in the past for Galil Medical.

References

  1. 1.
    Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res: Off J Am Assoc Cancer Res. 2006;15(12):6243–9.CrossRefGoogle Scholar
  2. 2.
    van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol:Off J Eur Soc Med Oncol/ESMO. 2007;18(9):1437–49.CrossRefGoogle Scholar
  3. 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
  4. 4.
    Plunkett TA, Smith P, Rubens RD. Risk of complications from bone metastases in breast cancer. implications for management. Eur J Cancer. 2000;36(4)):476–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Jimenez-Andrade JM, Mantyh WG, Bloom AP, Ferng AS, Geffre CP, Mantyh PW. Bone cancer pain. Ann N Y Acad Sci. 2010;1198:173–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Goblirsch MJ, Zwolak PP, Clohisy DR. Biology of bone cancer pain. Clin Cancer Res:Off J Am Assoc Cancer Res. 2006;12(20 Pt 2):6231–5.CrossRefGoogle Scholar
  7. 7.
    Soares LG, Chan VW. The rationale for a multimodal approach in the management of breakthrough cancer pain: a review. Am J Hosp Palliat Care. 2007;24(5):430–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Requarth J. Image-guided palliative care procedures. Surg Clin N Am. 2011;91(2):367–402.PubMedCrossRefGoogle Scholar
  9. 9.
    McCullough HK, Bain RM, Clark HP, Requarth JA. The radiologist as a palliative care subspecialist: providing symptom relief when cure is not possible. AJR Am J Roentgenol. 2011;196(2):462–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Bhaskar AK. Interventional management of cancer pain. Curr Opin Support Palliat Care. 2012;6(1):1–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Nazario J, Tam AL. Ablation of bone metastases. Surg Oncol Clin N Am. 2011;20(2):355–68.PubMedCrossRefGoogle Scholar
  12. 12.
    Nazario J, Hernandez J, Tam AL. Thermal ablation of painful bone metastases. Tech Vasc Interv Radiol. 2011;14(3):150–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenthal D, Callstrom MR. Critical review and state of the art in interventional oncology: benign and metastatic disease involving bone. Radiology. 2012;262(3):765–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Goldberg SN, Charboneau JW, Dodd 3rd GD, Dupuy DE, Gervais DA, Gillams AR, et al. Image-guided tumor ablation: proposal for standardization of terms and reporting criteria. Radiology. 2003;228(2):335–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Atwell TD, Farrell MA, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skelet Radiol. 2006;35(1):1–15.CrossRefGoogle Scholar
  16. 16.
    Munk PL, Rashid F, Heran MK, Papirny M, Liu DM, Malfair D, et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol: JVIR. 2009;20(7):903–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116(4):989–97.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol:Off J Am Soc Clin Oncol. 2004;22(2):300–6.CrossRefGoogle Scholar
  19. 19.
    Gangi A, Buy X. Percutaneous bone tumor management. Semin Interv Radiol. 2010;27(2):124–36.CrossRefGoogle Scholar
  20. 20.
    Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Interv Radiol. 2010;27(3):276–84.CrossRefGoogle Scholar
  21. 21.
    Prologo JD, Patel I, Buethe J, Bohnert N. Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol: JVIR. 2014;25(5):769–75.PubMedCrossRefGoogle Scholar
  22. 22.
    Patel IJ, Pirasteh A, Passalacqua MA, Robbin MR, Hsu DP, Buethe J, et al. Palliative procedures for the interventional oncologist. AJR Am J Roentgenol. 2013;201(4):726–35.PubMedCrossRefGoogle Scholar
  23. 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
  24. 24.
    Popken F, Michael JW, Zarghooni K, Sobottke R, Kasper HU, Blaecker D, et al. Stability changes after cryosurgery in long tubular bones in correlation to histological results: an animal trial. Arch Orthop Trauma Surg. 2009;129(6):857–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Castaneda Rodriguez WR, Callstrom MR. Effective pain palliation and prevention of fracture for axial-loading skeletal metastases using combined cryoablation and cementoplasty. Tech Vasc Interv Radiol. 2011;14(3):160–9.PubMedCrossRefGoogle Scholar
  26. 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. 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
  28. 28.
    Kurup AN, Woodrum DA, Morris JM, Atwell TD, Schmit GD, Welch TJ, et al. Cryoablation of recurrent sacrococcygeal tumors. J Vasc Interv Radiol: JVIR. 2012;23(8):1070–5.PubMedCrossRefGoogle Scholar
  29. 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. 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
  31. 31.
    Atwell TD, Farrell MA, Callstrom MR, Charboneau JW, Leibovich BC, Patterson DE, et al. Percutaneous cryoablation of 40 solid renal tumors with US guidance and CT monitoring: initial experience. Radiology. 2007;243(1):276–83.PubMedCrossRefGoogle Scholar
  32. 32.
    Truesdale CM, Soulen MC, Clark TW, Mondschein JI, Wehrenberg-Klee E, Malkowicz SB, et al. Percutaneous computed tomography-guided renal mass radiofrequency ablation versus cryoablation: doses of sedation medication used. J Vasc Interv Radiol: JVIR. 2013;24(3):347–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Hallenbeck JL. Pain Management. In: Hallenbeck JL, editor. Palliative Care Perspectives. New York: Oxford University Press; 2003. p. 39–43.CrossRefGoogle Scholar
  34. 34.
    Gordon DB, Stevenson KK, Griffie J, Muchka S, Rapp C, Ford-Roberts K. Opioid equianalgesic calculations. J Palliat Med. 1999;2(2):209–18.PubMedCrossRefGoogle Scholar
  35. 35.
    Gainford MC, Dranitsaris G, Clemons M. Recent developments in bisphosphonates for patients with metastatic breast cancer. BMJ. 2005;330(7494):769–73.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Brady D, Parker CC, O’Sullivan JM. Bone-targeting radiopharmaceuticals including radium-223. Cancer J. 2013;19(1):71–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Mani A SC. Bone Metastases. In: Walsh, TD, editor. Walsh: Palliative Medicine. 1st ed. Philadelphia: Saunders; 2009.Google Scholar
  38. 38.
    Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63(1):65–76.PubMedCrossRefGoogle Scholar
  39. 39.
    Wu JS, Wong R, Johnston M, Bezjak A, Whelan T. Cancer Care Ontario Practice Guidelines Initiative Supportive Care G. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003;55(3):594–605.PubMedCrossRefGoogle Scholar
  40. 40.
    Gaze MN, Kelly CG, Kerr GR, Cull A, Cowie VJ, Gregor A, et al. Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules. Radiother Oncol: J Eur Soc Ther Radiol Oncol. 1997;45(2):109–16.CrossRefGoogle Scholar
  41. 41.
    Agarawal JP, Swangsilpa T, van der Linden Y, Rades D, Jeremic B, Hoskin PJ. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol. 2006;18(10):747–60.CrossRefGoogle Scholar
  42. 42.
    Ingunn HC, Robert E. Bone Metastases. Abeloff’s clinical oncology. 4th ed. Philadelphia: Churchill Livingstone/Elsevier; 2008. p. 845–71.Google Scholar
  43. 43.
    Fairchild A CE. Palliative Radiation Therapy. In: Walsh, TD, editor. Walsh: Palliative Medicine. 1st ed. Philadelphia: Saunders; 2009.Google Scholar
  44. 44.
    Wegener B, Schlemmer M, Stemmler J, Jansson V, Durr HR, Pietschmann MF. Analysis of orthopedic surgery of bone metastases in breast cancer patients. BMC Musculoskelet Disord. 2012;13(1):232.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 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
  46. 46.
    Callstrom MR, Charboneau JW. Image-guided palliation of painful metastases using percutaneous ablation. Tech Vasc Interv Radiol. 2007;10(2):120–31.PubMedCrossRefGoogle Scholar
  47. 47.
    Kurup AN, Callstrom MR. Ablation of skeletal metastases: current status. J Vasc Interv Radiol: JVIR. 2010;21(8 Suppl):S242–50.PubMedCrossRefGoogle Scholar
  48. 48.
    Ng KK, Lam CM, Poon RT, Shek TW, To JY, Wo YH, et al. Comparison of systemic responses of radiofrequency ablation, cryotherapy, and surgical resection in a porcine liver model. Ann Surg Oncol. 2004;11(7):650–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Blackwell TS, Debelak JP, Venkatakrishnan A, Schot DJ, Harley DH, Pinson CW, et al. Acute lung injury after hepatic cryoablation: correlation with NF-kappa B activation and cytokine production. Surgery. 1999;126(3):518–26.PubMedCrossRefGoogle Scholar
  50. 50.
    Chapman WC, Debelak JP, Wright Pinson C, Washington MK, Atkinson JB, Venkatakrishnan A, et al. Hepatic cryoablation, but not radiofrequency ablation, results in lung inflammation. Ann Surg. 2000;231(5):752–61.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Gravante G, Sconocchia G, Ong SL, Dennison AR, Lloyd DM. Immunoregulatory effects of liver ablation therapies for the treatment of primary and metastatic liver malignancies. Liver Int: Off J Int Assoc Study Liver. 2009;29(1):18–24.CrossRefGoogle Scholar
  52. 52.
    Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, et al. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. J Hepato-Biliary-Pancreatic Sci. 2012;19(6):674–84.CrossRefGoogle Scholar
  53. 53.
    Jansen MC, van Hillegersberg R, Schoots IG, Levi M, Beek JF, Crezee H, et al. Cryoablation induces greater inflammatory and coagulative responses than radiofrequency ablation or laser induced thermotherapy in a rat liver model. Surgery. 2010;147(5):686–95.PubMedCrossRefGoogle Scholar
  54. 54.
    Soanes WA, Ablin RJ, Gonder MJ. Remission of metastatic lesions following cryosurgery in prostatic cancer: immunologic considerations. J Urol. 1970;104(1):154–9.PubMedGoogle Scholar
  55. 55.
    Ravindranath MH, Wood TF, Soh D, Gonzales A, Muthugounder S, Perez C, et al. Cryosurgical ablation of liver tumors in colon cancer patients increases the serum total ganglioside level and then selectively augments antiganglioside IgM. Cryobiology. 2002;45(1):10–21.PubMedCrossRefGoogle Scholar
  56. 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
  57. 57.
    Bang HJ, Littrup PJ, Currier BP, Goodrich DJ, Aoun HD, Klein LC, et al. Percutaneous cryoablation of metastatic lesions from non-small-cell lung carcinoma: initial survival, local control, and cost observations. J Vasc Interv Radiol: JVIR. 2012;23(6):761–9.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 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
  59. 59.
    Gage AA, Baust JG. Cryosurgery for tumors. J Am Coll Surg. 2007;205(2):342–56.PubMedCrossRefGoogle Scholar
  60. 60.
    Theodorescu D. Cancer cryotherapy: evolution and biology. Rev Urol. 2004;6 Suppl 4:S9–S19.PubMedPubMedCentralGoogle Scholar

Copyright information

© ISS 2014

Authors and Affiliations

  • J. David Prologo
    • 1
  • Matthew Passalacqua
    • 2
  • Indravadan Patel
    • 2
  • Nathan Bohnert
    • 2
  • David J. Corn
    • 3
  1. 1.Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided MedicineAtlantaUSA
  2. 2.Department of RadiologyUniversity Hospitals Case Medical CenterClevelandUSA
  3. 3.Departments of Radiology and Biomedical EngineeringUniversity Hospitals Case Medical CenterClevelandUSA

Personalised recommendations