Skip to main content


Log in

Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript



Radiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.


Fifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval.


Twenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported.


RFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Paget S. The distribution of secondary growths in cancer of the breast. 1889. Cancer Metastasis Rev. 1989;8:98–101.

    CAS  PubMed  Google Scholar 

  2. Boland PJ, Lane JM, Sundaresan N. Metastatic disease of the spine. Clin Orthop Relat Res. 1982;169:95–102.

    PubMed  Google Scholar 

  3. Harrington KD. Metastatic disease of the spine. J Bone Joint Surg Am. 1986;68:1110–5.

    CAS  PubMed  Google Scholar 

  4. Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine (Phila Pa 1976). 1990;15:1–4.

    Article  CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. Loblaw DA, Perry J, Chambers A, Laperriere NJ. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. J Clin Oncol. 2005;23:2028–37.

    Article  PubMed  Google Scholar 

  7. Harel R, Angelov L. Spine metastases: current treatments and future directions. Eur J Cancer. 2010;46:2696–707.

    Article  PubMed  Google Scholar 

  8. Gangi A, Sabharwal T, Irani FG, Buy X, Morales JP, Adam A. Quality assurance guidelines for percutaneous vertebroplasty standards of practice committee of the society of interventional radiology. Cardiovasc Interv Radiol. 2006;29(2):173–8.

    Article  Google Scholar 

  9. Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007;25(11):1423–36.

    Article  PubMed  Google Scholar 

  10. Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol. 2013;14:e310–20.

    Article  PubMed  Google Scholar 

  11. Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, Conchiglia A, Ventura L, Franzese P, Gallucci M, Masciocchi C, Tombolini V. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol. 2011;21:2004–10.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  13. Algra PR, Heimans JJ, Valk J, Nauta JJ, Lachniet M, Van Kooten B. Do metastases in vertebrae begin in the body or the pedicles? Imaging study in 45 patients. AJR Am J Roentgenol. 1992;158:1275–9.

    Article  CAS  PubMed  Google Scholar 

  14. Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, Paz-Fumagalli R, Hoffman C, Atwell TD, Charboneau JW, Schmit GD, Goetz MP, Rubin J, Brown KJ, Novotny PJ, Sloan JA. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013;119:1033–41.

    Article  PubMed  Google Scholar 

  15. Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, Lopez R, Safran H, DiPetrillo T. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116:989–97.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anchala PR, Irving WD, Hillen TJ, Friedman MV, Georgy BA, Coldwell DM, Tran ND, Vrionis FD, Brook A, Jennings JW. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Phys. 2014;17:317–27.

    Google Scholar 

  17. Hillen TJ, Anchala P, Friedman MV, Jennings JW. Treatment of metastatic posterior vertebral body osseous tumors by using a targeted bipolar radiofrequency ablation device: technical note. Radiology. 2014;273:261–7.

    Article  PubMed  Google Scholar 

  18. Lane MD, Le HB, Lee S, Young C, Heran MK, Badii M, Clarkson PW, Munk PL. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skelet Radiol. 2011;40:25–32.

    Article  Google Scholar 

  19. Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol. 2015;124(1):111–8. doi:10.1007/s11060-015-1813-2 Epub 2015 May 29.

    Article  PubMed  Google Scholar 

  20. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. Phys Ther. 2001;81:776–88.

    CAS  PubMed  Google Scholar 

  21. Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.

    CAS  PubMed  Google Scholar 

  22. Yanez B, Pearman T, Lis CG, Beaumont JL, Cella D. The FACT-G7: a rapid version of the functional assessment of cancer therapy-general (FACT-G) for monitoring symptoms and concerns in oncology practice and research. Ann Oncol. 2013;24:1073–8.

    Article  CAS  PubMed  Google Scholar 

  23. Broom R, Du H, Clemons M, Eton D, Dranitsaris G, Simmons C, Ooi W, Cella D. Switching breast cancer patients with progressive bone metastases to third-generation bisphosphonates: measuring impact using the Functional Assessment of Cancer Therapy-Bone Pain. J Pain Symptom Manag. 2009;38:244–57.

    Article  CAS  Google Scholar 

  24. Pearman T, Yanez B, Peipert J, Wortman K, Beaumont J, Cella D. Ambulatory cancer and US general population reference values and cutoff scores for the functional assessment of cancer therapy. Cancer. 2014;120:2902–9.

    Article  PubMed  Google Scholar 

  25. Services Usdohah. National Cancer Institute, National Institutes of Health. Common Terminology Criteria for Adverse Events (CTCAE) 2009; (v4.03: June 14, 2010).

  26. Callstrom MR, York JD, Gaba RC, Gemmete JJ, Gervais DA, Millward SF, Brown DB, Dupuy D, Goldberg SN, Kundu S, Rose SC, Thomas JJ, Cardella JF. Research reporting standards for image-guided ablation of bone and soft tissue tumors. J Vasc Interv Radiol. 2009;20(12):1527–40.

    Article  PubMed  Google Scholar 

  27. 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. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22:300–6.

    Article  PubMed  Google Scholar 

  28. Proschek D, Kurth A, Proschek P, Vogl TJ, Mack MG. Prospective pilot-study of combined bipolar radiofrequency ablation and application of bone cement in bone metastases. Anticancer Res. 2009;29(7):2787–92.

    PubMed  Google Scholar 

  29. Johnstone C, Lutz S. External beam radiotherapy and bone metastases. Ann Palliat Med. 2014;3:114–22.

    PubMed  Google Scholar 

  30. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. A novel classification system for spinal instability in neoplastic disease. Spine. 2010;35(22):1221–9.

    Article  Google Scholar 

  31. Cruz JP, Sahgal A, Whyne C, Fehlings MG, Smith R. Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease. J Neurosurg Spine. 2014;21:372–7.

    Article  PubMed  Google Scholar 

  32. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.

    Article  CAS  PubMed  Google Scholar 

  33. NCCN Guidelines Adult Cancer Pain ver. 22014.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sandeep Bagla.

Ethics declarations

Conflicts of interest

Sandeep Bagla reports other from DFINE Inc. during the conduct of the study. Dawood Sayed reports personal fees from DFINE Inc. outside the submitted work. Jayson Brower reports other from DFINE Inc. outside the submitted work. J. Neal Rutledge reports non-financial support from DFINE Inc. during the conduct of the study; personal fees from DFINE Inc. outside the submitted work. James Carlisle reports grants from DFINE Inc. during the conduct of the study. Ilya Lekht reports grants from null during the conduct of the study. Bassem Georgy reports other from DFINE Inc. during the conduct of the study and other from DFINE Inc. outside the submitted work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bagla, S., Sayed, D., Smirniotopoulos, J. et al. Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases. Cardiovasc Intervent Radiol 39, 1289–1297 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: