Thermal ablation techniques: a curative treatment of bone metastases in selected patients?
- 754 Downloads
Thermal ablation techniques (radiofrequency-ablation/cryotherapy) can be indicated with a curative intent. The success rate and prognostic factors for complete treatment were analysed.
The medical records of all patients who had undergone curatively intended thermal ablation of bone metastases between September 2001 and February 2012 were retrospectively analysed. The goal was to achieve complete treatment of all bone metastases in patients with oligometastatic disease (group 1) or only of bone metastases that could potentially lead to skeletal-related events in patients with a long life expectancy (group 2). We report the rate of complete treatment according to patient characteristics, primary tumour site, bone metastasis characteristics, radiofrequency ablation/cryotherapy and the treatment group (group 1/group 2).
Eighty-nine consecutive patients had undergone curatively intended thermal ablation of 122 bone metastases. The median follow-up was 22.8 months [IQR = 12.2-44.4]. In the intent-to-treat analysis, the 1-year complete treatment rate was 67 % (95%CI: 50 %-76 %). In the multivariate analysis the favourable prognostic factors for complete local treatment were oligometastatic status (p = 0.02), metachronous (p = 0.004) and small-sized (p = 0.001) bone metastases, without cortical bone erosion (p = 0.01) or neurological structures in the vicinity (p = 0.002).
Thermal ablation should be included in the therapeutic arsenal for the cure of bone metastases.
• Thermal ablation techniques are currently performed to palliate pain caused by bone metastases.
• In selected patients, thermal ablation can also be indicated with a curative intent.
• Oligometastatic and/or metachronous diseases are good prognostic factors for local success.
• Small-size (<2 cm) bone metastases and no cortical erosion are good prognostic factors.
KeywordsBone metastases Thermal ablation Oligometastases Cryotherapy Radiofrequency ablation
Bone disease-free survival
The scientific guarantor of this publication is Prof. Thierry de Baere. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise (Dr Anne Auperin). Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.
- 13.Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, Wong GY, Sloan JA, Novotny PJ, Petersen IA, Beres RA, Regge D, Capanna R, Saker MB, Grönemeyer DH, Gevargez A, Ahrar K, Choti MA, de Baere TJ, Rubin J (2004) Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 22:300–306PubMedCrossRefGoogle Scholar
- 19.Salama JK, Hasselle MD, Chmura SJ, Malik R, Mehta N, Yenice KM, Villaflor VM, Stadler WM, Hoffman PC, Cohen EE, Connell PP, Haraf DJ, Vokes EE, Hellman S, Weichselbaum RR (2012) Stereotactic body radiotherapy for multisite extracranial oligometastases: final report of a dose escalation trial in patients with 1 to 5 sites of metastatic disease. Cancer 118:2962–2970PubMedCrossRefGoogle Scholar
- 20.Fumagalli I, Bibault JE, Dewas S, Kramar A, Mirabel X, Prevost B, Lacornerie T, Jerraya H, Lartigau E (2012) A single-institution study of stereotactic body radiotherapy for patients with unresectable visceral pulmonary or hepatic oligometastases. Radiat Oncol 7:164PubMedCentralPubMedCrossRefGoogle Scholar
- 21.De Ruysscher D, Wanders R, van Baardwijk A, Dingemans AM, Reymen B, Houben R, Bootsma G, Pitz C, van Eijsden L, Geraedts W, Baumert BG, Lambin P (2012) Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases: long-term results of a prospective phase II trial (Nct01282450). J Thorac Oncol 7:1547–1555PubMedCrossRefGoogle Scholar
- 31.McMenomy BP, Kurup AN, Johnson GB, Carter RE, McWilliams RR, Markovic SN, Atwell TD, Schmit GD, Morris JM, Woodrum DA, Weisbrod AJ, Rose PS, Callstrom MR (2013) Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol 24:207–213PubMedCrossRefGoogle Scholar