Thermal ablation to relieve pain from metastatic bone disease: a systematic review

  • Nicolò GennaroEmail author
  • Luca Maria Sconfienza
  • Federico Ambrogi
  • Sara Boveri
  • Ezio Lanza
Review Article



To review the efficacy of percutaneous thermal ablation (TA) of bone metastases (radiofrequency ablation [RFA], microwave ablation [MWA], cryoablation [CA], and MR-guided focused ultrasound [MRgFUS]) in reducing pain in patients with advanced stage cancer.

Materials and Methods

We searched MEDLINE/PubMed, MEDLINE In-Process, BIDS ISI, Embase, CINAHL, and the Cochrane database using the keywords “ablation,” “painful,” “bone,” and “metastases” combined in multiple algorithms. Inclusion criteria were: original clinical studies published between 2001 and 2018; performance of RFA, MWA, CA or MRgFUS; and quantitative pain assessment before/after TA of bone metastasis.


Eleven papers (3 on RFA, 1 on MWA, 2 on CA, and 5 on MRgFUS) involving 364 patients were reviewed. A technical success rate of 96–100% was reported, with follow-up for up to 6 months. At baseline, pain scores ranged from 5.4 to 8, at 1–4 weeks from 0.5 to 5, and at 12 weeks from 0.3 to 4.5. Mean pain reduction compared with baseline ranged from 26 to 91% at 4 weeks and from 16% to 95% at 12 weeks. MWA treatments caused no complications, whereas MRgFUS showed the highest complication rate. The number of minor complications observed ranged from 0 to 59 (complication ratio 0–1.17), whereas the number of significant adverse effects ranged from 0 to 4 (complication ratio 0–0.04).


All techniques achieved pain relief after 1 and 3 months, in up to 91% and 95% of patients respectively. MWA showed a negligible complication rate, whereas MRgFUS is associated with a noteworthy rate of adverse events. Future studies should adopt a standardized pain reporting scale to allow for meta-analysis.


Pain Bone Metastasis Radiofrequency Microwave Focused ultrasound Cryoablation Ablation 



Radiofrequency ablation


Microwave ablation


Magnetic resonance-guided focused ultrasound




Standard deviation


Standard error


Absolute deviation


Interquartile range



We thank Arturo Chiti (Humanitas University, Rozzano) for revising the manuscript and Dr Luigi Cazzato (CHRU de Strasbourg, France) for providing Figs. 3 and 4.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Specialization School in RadiologyHumanitas UniversityPieve EmanueleItaly
  2. 2.Unità Operativa di Radiologia Diagnostica e InterventisticaIRCCS Istituto Ortopedico Galeazzi20161 MilanoItaly
  3. 3.Department of Clinical Sciences and Community Health, University of Milan20122 MilanoItaly
  4. 4.Direzione ScientificaIRCCS Policlinico San Donato20097 San Donato MilaneseItaly
  5. 5.Dipartimento di Radiologia Diagnostica e InterventisticaHumanitas Research HospitalRozzanoItaly

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