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



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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4



Radiofrequency ablation


Microwave ablation


Magnetic resonance-guided focused ultrasound




Standard deviation


Standard error


Absolute deviation


Interquartile range


  1. 1.

    Li S, Peng Y, Weinhandl ED, Blaes AH, Cetin K, Chia VM, et al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012;4:87–93.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Yong M, Jensen AÖ, Jacobsen JB, Nørgaard M, Fryzek JP, Sørensen HT. Survival in breast cancer patients with bone metastases and skeletal-related events: a population-based cohort study in Denmark (1999-2007). Breast Cancer Res Treat. 2011;129:495–503.

    PubMed  Google Scholar 

  3. 3.

    Zeng L, Chow E, Bedard G, Zhang L, Fairchild A, Vassiliou V, et al. Quality of life after palliative radiation therapy for patients with painful bone metastases: results of an international study validating the EORTC QLQ-BM22. Int J Radiat Oncol Biol Phys. 2012;84:e337–42.

    PubMed  Google Scholar 

  4. 4.

    Nielsen OS, Munro AJ, Tannock IF. Bone metastases: pathophysiology and management policy. J Clin Oncol. 1991;9:509–24.

    CAS  PubMed  Google Scholar 

  5. 5.

    Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Intervent Radiol. 2010;27:276–84.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Higgins JP, Green S, The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions v 5.1.0 [Internet]. 2011 [cited 12 June 2016]. Available from:

  8. 8.

    Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. J Vasc Interv Radiol. 2014;25:1691–705.e4.

  9. 9.

    Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.

    PubMed  Google Scholar 

  10. 10.

    Lanza E, Palussiere J, Buy X, Grasso RF, Beomonte Zobel B, Poretti D, et al. Percutaneous image-guided cryoablation of breast cancer: a systematic review. J Vasc Interv Radiol. 2015;26:1652–7.e1.

    Google Scholar 

  11. 11.

    Lanza E, Banfi G, Serafini G, Lacelli F, Orlandi D, Bandirali M, et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol. 2015;25:2176–83.

    PubMed  Google Scholar 

  12. 12.

    Cazzato RL, Palussière J, Buy X, Denaro V, Santini D, Tonini G, et al. Percutaneous long bone cementoplasty for palliation of malignant lesions of the limbs: a systematic review. Cardiovasc Intervent Radiol. 2015;38:1563–72.

    PubMed  Google Scholar 

  13. 13.

    Lanza E, Thouvenin Y, Viala P, Sconfienza LM, Poretti D, Cornalba G, et al. Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting. Cardiovasc Intervent Radiol. 2014;37:1530–9.

    PubMed  Google Scholar 

  14. 14.

    Catane R, Beck A, Inbar Y, Rabin T, Shabshin N, Hengst S, et al. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases—preliminary clinical experience. Ann Oncol. 2007;18:163–7.

    CAS  PubMed  Google Scholar 

  15. 15.

    Hurwitz MD, Ghanouni P, Kanaev SV, Iozeffi D, Gianfelice D, Fennessy FM, et al. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. J Natl Cancer Inst. 2014;106:dju082.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    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;116:989–97.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Wong GY, Sloan JA, et al. Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation. Radiology. 2002;224:87–97.

    PubMed  Google 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. 2004;22:300–6.

    PubMed  Google Scholar 

  19. 19.

    Kastler A, Alnassan H, Aubry S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. J Vasc Interv Radiol. 2014;25:1470–5.

    PubMed  Google Scholar 

  20. 20.

    Gianfelice D, Gupta C, Kucharczyk W, Bret P, Havill D, Clemons M. Palliative treatment of painful bone metastases with MR imaging-guided focused ultrasound. Radiology. 2008;249:355–63.

    PubMed  Google Scholar 

  21. 21.

    Liberman B, Gianfelice D, Inbar Y, Beck A, Rabin T, Shabshin N, et al. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol. 2009;16:140–6.

    PubMed  Google Scholar 

  22. 22.

    Tomasian A, Wallace A, Northrup B, Hillen TJ, Jennings JW. Spine cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR Am J Neuroradiol. 2016;37:189–95.

    CAS  PubMed  Google Scholar 

  23. 23.

    Wallace AN, McWilliams SR, Connolly SE, Symanski JS, Vaswani D, Tomasian A, et al. Percutaneous image-guided cryoablation of musculoskeletal metastases: pain palliation and local tumor control. J Vasc Interv Radiol. 2016;27:1788–96.

    PubMed  Google Scholar 

  24. 24.

    Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12:6243s–9s.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    van den Beuken-van Everdingen MHJ, 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. 2007;18:1437–49.

    Google Scholar 

  26. 26.

    Carrafiello G, Laganà D, Pellegrino C, Mangini M, Fontana F, Piacentino F, et al. Ablation of painful metastatic bone tumors: a systematic review. Int J Surg. 2008;6(Suppl 1):S47–52.

    PubMed  Google Scholar 

  27. 27.

    Choi J, Raghavan M. Diagnostic imaging and image-guided therapy of skeletal metastases. Cancer Control. 2012;19:102–12.

    PubMed  Google Scholar 

  28. 28.

    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. Skeletal Radiol. 2006;35:1–15.

    PubMed  Google Scholar 

  29. 29.

    Lee JH, Stein M, Roychowdhury S. Percutaneous treatment of a sacral metastasis with combined embolization, cryoablation, alcohol ablation and sacroplasty for local tumor and pain control. Interv Neuroradiol. 2013;19:250–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Botsa E, Mylona S, Koutsogiannis I, Koundouraki A, Thanos L. CT image guided thermal ablation techniques for palliation of painful bone metastases. Ann Palliat Med. 2014;3:47–53.

    PubMed  Google Scholar 

  31. 31.

    Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24:229–33.

    PubMed  Google Scholar 

  32. 32.

    Mauri G, Orsi F, Sconfienza LM. Systemic effects of local tumor ablation: oncogenesis and antitumor induced immunity. Radiology. 2017;283:923.

    PubMed  Google Scholar 

  33. 33.

    Callstrom MR, Charboneau JW. Image-guided palliation of painful metastases using percutaneous ablation. Tech Vasc Interv Radiol. 2007;10:120–31.

    PubMed  Google Scholar 

  34. 34.

    Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what should you use and why? Radiographics. 2014;34:1344–62.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Lubner MG, Brace CL, Hinshaw JL, Lee FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol. 2010;21:S192–203.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Dababou S, Marrocchio C, Scipione R, Erasmus H-P, Ghanouni P, Anzidei M, et al. High-intensity focused ultrasound for pain management in patients with cancer. Radiographics. 2018;38:603–23.

    PubMed  Google Scholar 

  37. 37.

    Napoli A, Anzidei M, Marincola BC, Brachetti G, Noce V, Boni F, et al. MR imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics. 2013;33:1555–68.

    PubMed  Google Scholar 

  38. 38.

    Mauri G, Pisani Mainini A, Monaco C, Pescatori LC, De Angelis C, Sconfienza LM. Urgent need to apply a common language in image-guided thermal ablations. J Ultrasound. 2018;21:77–8.

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    David E, Kaduri S, Yee A, Chow E, Sahgal A, Chan S, et al. Initial single center experience: radiofrequency ablation assisted vertebroplasty and osteoplasty using a bipolar device in the palliation of bone metastases. Ann Palliat Med. 2017;6:118–24.

    PubMed  Google Scholar 

  40. 40.

    Zhang Q, Zhang K, Xie B, Ren Y, Li G, Zhang L, et al. Analysis of curative effect of I 125 implantation combined with radiofrequency ablation in treating bone metastases. J Bone Oncol. 2018;11:23–6.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Yang P-L, He X-J, Li H-P, Zang Q-J, Wang G-Y. Image-guided minimally invasive percutaneous treatment of spinal metastasis. Exp Ther Med. 2017;13:705–9.

    PubMed  PubMed Central  Google Scholar 

  42. 42.

    Ma Y, Wallace AN, Waqar SN, Morgensztern D, Madaelil TP, Tomasian A, et al. Percutaneous image-guided ablation in the treatment of osseous metastases from non-small cell lung cancer. Cardiovasc Intervent Radiol. 2018;41:726–33.

    PubMed  Google Scholar 

  43. 43.

    Li F, Wang W, Li L, Chang Y, Su D, Guo G, et al. An effective therapy to painful bone metastases: cryoablation combined with zoledronic acid. Pathol Oncol Res. 2014;20:885–91.

    CAS  PubMed  Google Scholar 

  44. 44.

    Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol. 2016;39:74–80.

    PubMed  Google Scholar 

  45. 45.

    Wu JS-Y, RKS W, Lloyd NS, Johnston M, Bezjak A, Whelan T, et al. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases—an evidence-based practice guideline. BMC Cancer. 2004;4:71.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, et al. Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017;7:4–12.

    PubMed  Google Scholar 

  47. 47.

    Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases: final results of the study by the radiation therapy oncology group. Cancer. 1982;50:893–9.

    CAS  PubMed  Google Scholar 

  48. 48.

    Lutz S, Chow E. A review of recently published radiotherapy treatment guidelines for bone metastases: contrasts or convergence? J Bone Oncol. 2012;1:18–23.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18:744–51.

    PubMed  PubMed Central  Google Scholar 

  50. 50.

    Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011;79:965–76.

    PubMed  Google Scholar 

  51. 51.

    Gennaro N, Mauri G, Della Vigna P. IR combined with other treatment modalities in bone tumors. In: Cazzato RL. Interventional bone tumor management. Torino: Minerva Medica Publishing; 2019. In press.

  52. 52.

    Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, et al. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol. 2011;21:2004–10.

    PubMed  Google Scholar 

  53. 53.

    Thermal ablation and stereotactic spine radiosurgery (SSRS). Accessed 12 February 2018. Available from:

  54. 54.

    De Felice F, Piccioli A, Musio D, Tombolini V. The role of radiation therapy in bone metastases management. Oncotarget. 2017;8:25691–9.

    PubMed  PubMed Central  Google Scholar 

  55. 55.

    Lane MD, Le HBQ, Lee S, Young C, Heran MKS, Badii M, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol. 2011;40:25–32.

    PubMed  Google Scholar 

  56. 56.

    Overduin CG, Jenniskens SFM, Sedelaar JPM, Bomers JGR, Fütterer JJ. Percutaneous MR-guided focal cryoablation for recurrent prostate cancer following radiation therapy: retrospective analysis of iceball margins and outcomes. Eur Radiol. 2017;27:4828–36.

    PubMed  PubMed Central  Google Scholar 

  57. 57.

    Crabtree T, Puri V, Timmerman R, Fernando H, Bradley J, Decker PA, et al. Treatment of stage I lung cancer in high-risk and inoperable patients: comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033). J Thorac Cardiovasc Surg. 2013;145:692–9.

    PubMed  Google Scholar 

  58. 58.

    Hadji P, Aapro M, Costa L, Gnant M. Antiresorptive treatment options and bone health in cancer patients—safety profiles and clinical considerations. Cancer Treat Rev. 2012;38:815–24.

    CAS  PubMed  Google Scholar 

  59. 59.

    Pilot study of stereotactic ablation for oligometastatic breast neoplasia in combination with the anti-PD-1 antibody MK-3475. Accessed 12 February 2018. Available from:

  60. 60.

    Ibrahim T, Mercatali L, Amadori D. Bone and cancer: the osteoncology. Clin Cases Miner Bone Metab. 2013;10:121–3.

    PubMed  PubMed Central  Google Scholar 

Download references


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.

Author information



Corresponding author

Correspondence to Nicolò Gennaro.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gennaro, N., Sconfienza, L.M., Ambrogi, F. et al. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol 48, 1161–1169 (2019).

Download citation


  • Pain
  • Bone
  • Metastasis
  • Radiofrequency
  • Microwave
  • Focused ultrasound
  • Cryoablation
  • Ablation