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Percutaneous microwave ablation of bone tumors: a systematic review

  • Musculoskeletal
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Abstract

Aim

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.

Results

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.

Conclusion

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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Abbreviations

CA:

Cryoablation

CI:

Confidence intervals

CT:

Computed tomography

MINORS:

Methodological Index for Non-Randomized Studies

MRI:

Magnetic resonance imaging

MWA:

Microwave ablation

NRS:

Numerical rating scale

ODI:

Oswestry Disability Index

OO:

Osteoid osteomas

PET-CT:

Positron emission tomography computed tomography

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RFA:

Radiofrequency ablation

References

  1. Coleman RE (2001) Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 27(3):165–176

    Article  CAS  Google Scholar 

  2. Macedo F, Ladeira K, Pinho F et al (2017) Bone metastases: an overview. Oncol Rev 11(1):321

    PubMed  PubMed Central  Google Scholar 

  3. Cazzato RL, Arrigoni F, Boatta E et al (2019) Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 124(1):34–49

    Article  Google Scholar 

  4. Gangi A, Tsoumakidou G, Buy X, Quoix E (2010) Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol 33(4):706–713

    Article  CAS  Google Scholar 

  5. Koch G, Cazzato RL, Gilkison A, Caudrelier J, Garnon J, Gangi A (2018) Percutaneous treatments of benign bone tumors. Semin Intervent Radiol 35(4):324–332

    Article  Google Scholar 

  6. Rehnitz C, Sprengel SD, Lehner B et al (2012) CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: clinical success and long-term follow up in 77 patients. Eur J Radiol 81(11):3426–3434

    Article  Google Scholar 

  7. Miyazaki M, Arai Y, Myoui A et al (2016) Phase I/II multi-institutional study of percutaneous radiofrequency ablation for painful osteoid osteoma (JIVROSG-0704). Cardiovasc Intervent Radiol 39(10):1464–1470

    Article  Google Scholar 

  8. Tanigawa N, Arai Y, Yamakado K et al (2018) Phase I/II study of radiofrequency ablation for painful bone metastases: Japan interventional radiology in oncology study group 0208. Cardiovasc Intervent Radiol 41(7):1043–1048

    Article  Google Scholar 

  9. Goetz MP, Callstrom MR, Charboneau JW et al (2004) Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 22(2):300–306

    Article  Google Scholar 

  10. Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A (2018) Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety. Int J Hyperthermia 34(8):1–10

    Google Scholar 

  11. Callstrom MR, Dupuy DE, Solomon SB et al (2013) Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 119(5):1033–1041

    Article  Google Scholar 

  12. Santiago E, Pauly V, Brun G, Guenoun D, Champsaur P, Le Corroller T (2018) Percutaneous cryoablation for the treatment of osteoid osteoma in the adult population. Eur Radiol 28(6):2336–2344

    Article  Google Scholar 

  13. Whitmore MJ, Hawkins CM, Prologo JD et al (2016) Cryoablation of osteoid osteoma in the pediatric and adolescent population. J Vasc Interv Radiol 27(2):232–237 quiz 238

    Article  Google Scholar 

  14. Brace CL (2009) Microwave ablation technology: what every user should know. Curr Probl Diagn Radiol 38(2):61–67

    Article  Google Scholar 

  15. Cazzato RL, De Marini P, Leclerc L et al (2020) Large nearly spherical ablation zones are achieved with simultaneous multi-antenna microwave ablation applied to treat liver tumours. Eur Radiol 30(2):971–975

    Article  Google Scholar 

  16. Pusceddu C, Melis L, Ballicu N et al (2018) Percutaneous microwave ablation under CT guidance for hepatocellular carcinoma: a single institutional experience. J Gastrointest Cancer 49(3):295–301

    Article  Google Scholar 

  17. Ma S, Ding M, Li J et al (2017) Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma: clinical outcomes and prognostic factors. J Cancer Res Clin Oncol 43(1):131–142

    Article  Google Scholar 

  18. Alexander ES, Wolf FJ, Machan JT et al (2015) Microwave ablation of focal hepatic malignancies regardless of size: a 9-year retrospective study of 64 patients. Eur J Radiol 84(6):1083–1090

    Article  Google Scholar 

  19. Wei Z, Zhang K, Ye X et al (2015) Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer. Skeletal Radiol 44(10):1485–1490

    Article  Google Scholar 

  20. Rinzler ES, Shivaram GM et al (2019) Microwave ablation of osteoid osteoma: initial experience and efficacy. Pediatr Radiol 49(4):566–570

    Article  Google Scholar 

  21. Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L (2016) Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol 39(1):74–80

    Article  Google Scholar 

  22. Prud’homme C, Nueffer JP, Runge M, Dubut J, Kastler B, Aubry S (2017) Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas. Skeletal Radiol 46(3):315–323

    Article  Google Scholar 

  23. Khan MA, Deib G, Deldar B, Patel AM, Barr JS (2018) Efficacy and safety of percutaneous microwave ablation and cementoplasty in the treatment of painful spinal metastases and myeloma. AJNR Am J Neuroradiol 39(7):1376–1383

    Article  CAS  Google Scholar 

  24. Kastler A, Alnassan H, Aubry S, Kastler B (2014) Microwave thermal ablation of spinal metastatic bone tumors. J Vasc Interv Radiol 25(9):1470–1475

    Article  Google Scholar 

  25. Deib G, Deldar B, Hui F, Barr JS, Khan MA (2019) Percutaneous microwave ablation and cementoplasty: clinical utility in the treatment of painful extraspinal osseous metastatic disease and myeloma. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.18.20386

  26. Auloge P, Cazzato RL, Rousseau C et al (2019) Complications of percutaneous bone tumor cryoablation: a 10-year experience. Radiology. 291(2):521–528

    Article  Google Scholar 

  27. Cazzato RL, Palussière J, Auloge P et al (2020) Complications following percutaneous image-guided radiofrequency ablation of bone tumors: a 10-year dual-center experience. Radiology. 296(1):227–235

    Article  Google Scholar 

  28. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  Google Scholar 

  29. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (2003) Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology. 229(1):171–175

    Article  Google Scholar 

  30. Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E (2019) Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol 48(8):1161–1169

    Article  Google Scholar 

  31. Tsoumakidou G, Thénint MA, Garnon J, Buy X, Steib JP, Gangi A (2016) Percutaneous image-guided laser photocoagulation of spinal osteoid osteoma: a single-institution series. Radiology. 278(3):936–943

    Article  Google Scholar 

  32. Thacker PG, Callstrom MR, Curry TB et al (2011) Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients’ immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol 197(2):510–515

    Article  Google Scholar 

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Correspondence to Roberto Luigi Cazzato.

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The scientific guarantor of this publication is Pr Afshin GANGI.

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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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• Systematic review of the literature

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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). https://doi.org/10.1007/s00330-020-07382-8

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  • DOI: https://doi.org/10.1007/s00330-020-07382-8

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