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Percutaneous microwave ablation of bone tumors: a systematic review

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript



To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors.

Materials and methods

A systematic literature search was conducted using PubMed, the Cochrane Library, EMBASE, and Web of Science database. Data concerning patient demographics, tumor characteristics, procedure, complications, and clinical outcomes were extracted and analyzed.


Seven non-comparative studies (6 retrospective, 1 prospective) were included accounting for 249 patients and 306 tumors (244/306 [79.7%] metastases; 25/306 [8.2%] myelomas, and 37/306 [12.1%] osteoid osteomas [OO]). In malignant tumors, MWA power was 30–70 W (except in one spinal tumors series where a mean power of 13.3 W was used) with pooled mean ablation time of 308.3 s. With OO, MWA power was 30–60 W with mean ablation time of 90–102 s. Protective measures were very sporadically used in 5 studies. Additional osteoplasty was performed in 199/269 (74.0%) malignant tumors. Clinically significant complications were noted in 10/249 (4.0%) patients. For malignant tumors, estimated pain reduction on the numerical rating scale was 5.3/10 (95% confidence intervals [95%CI] 4.6–6.1) at 1 month; and 5.3/10 (95% CI 4.3–6.3) at the last recorded follow-up (range 20–24 weeks in 4/5 studies). For OO, at 1-month follow-up, effective pain relief was noted in 92.3–100% of patients.


MWA is effective in achieving pain relief at short- (1 month) and mid-term (4–6 months) for painful OO and malignant bone tumors, respectively. Although MWA seems safe, further prospective studies are warranted to further assess this aspect, and to standardize MWA protocols.

Key Points

• Large heterogeneity exists across literature about ablation protocols used with microwave ablation applied for the treatment of benign and malignant bone tumors.

• Although microwave ablation of bone tumors appears safe, further studies are needed to assess this aspect, as current literature does not allow definitive conclusions.

• Nevertheless, microwave ablation is effective in achieving pain relief at short- (1 month) and mid-term (4–6 months) for painful osteoid osteomas and malignant bone tumors, respectively.

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Confidence intervals


Computed tomography


Methodological Index for Non-Randomized Studies


Magnetic resonance imaging


Microwave ablation


Numerical rating scale


Oswestry Disability Index


Osteoid osteomas


Positron emission tomography computed tomography


Preferred Reporting Items for Systematic Reviews and Meta-Analyses


Radiofrequency ablation


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Correspondence to Roberto Luigi Cazzato.

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The scientific guarantor of this publication is Pr Afshin GANGI.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was not required because this study is a systematic review of literature.

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Institutional Review Board approval was not required because this study is a systematic review of literature.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the seven included studies used for the final analysis.


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Cazzato, R.L., de Rubeis, G., de Marini, P. et al. Percutaneous microwave ablation of bone tumors: a systematic review. Eur Radiol 31, 3530–3541 (2021).

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