Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience

Terapie ablative percutanee imaging-guidate nel trattamento delle metastasi ossee sintomatiche: esperienza preliminare

  • Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The treatment of pain in bone metastases is currently multidisciplinary. Among the various therapies, local radiotherapy is the gold standard for pain palliation from single metastasis, even though the maximum benefit is obtained between 12 and 20 weeks from initiation. In carefully selected patients, several ablation therapies achieve this objective in 4 weeks. The purpose of this study was to assess the technical success, effectiveness and possible complications of percutaneous ablation therapies in patients with symptomatic bone metastases.

Materials and methods

From November 2003 to May 2008, ten ablation treatments were performed in ten patients with acute pain from metastatic bone lesions. Patient selection and choice of the most appropriate ablation treatment was made based on lesion characteristics. Three patients were treated with radiofrequency, one with plasma-mediated radiofrequency, two with plasma-mediated radiofrequency and cementoplasty, three with radiofrequency and cementoplasty and one with microwave.

Results

Assessments were based not only on imaging but also on the visual analogue scale (VAS) score for determining pain and on changes in morphine-equivalent doses. In both cases, 3-month follow-up showed a statistically significant reduction of pain. In no case did local complications occur either during or after treatment. Only one patient treated with radiofrequency (1/9, 11%) developed low-grade fever and general malaise during the 6 days following the procedure, compatible with a post-radiofrequency syndrome, which was treated with acetaminophen (paracetamol) only and resolved on day 7.

Conclusions

Percutaneous ablation therapies represent a safe and valuable alternative for treating localised pain from single bone metastasis, providing rapid (4-week) relief of symptoms and a significant reduction in morphine doses. This contributes to improving the quality of life of patients with metastatic disease.

Riassunto

Obiettivi

Il trattamento del dolore nelle metastasi ossee è attualmente multidisciplinare. Tra le varie terapie, la radioterapia locale è il gold-standard nella palliazione del dolore da metastasi singola, anche se il massimo beneficio si ottiene tra le 12 e le 20 settimane dall’inizio della terapia. In pazienti accuratamente selezionati, varie terapie ablative raggiungono quest’obiettivo in 4 settimane. Scopo di questo lavoro è valutare il successo tecnico, l’efficacia e le eventuali complicanze delle terapie ablative percutanee in pazienti affetti da metastasi ossee sintomatiche.

Materiali e metodi

Da novembre 2003 a maggio 2008 sono stati effettuati 10 trattamenti in 10 pazienti con dolore acuto da lesioni metastatiche ossee. La selezione dei pazienti e la scelta del trattamento ablativo più idoneo è stata fatta sulla base delle caratteristiche della lesione. Tre pazienti sono stati trattati con radiofrequenza, 1 con radiofrequenza plasma-mediata, 2 con radiofrequenza plasma mediata e cementoplastica, 3 con radiofrequenza e cementoplastica, 1 con microonde.

Risultati

La valutazione è stata effettuata non solo con imaging, ma anche con una VAS score (visual analoge scale) per la determinazione del dolore e con la variazione delle dose equivalenti di morfina. In entrambi i casi la riduzione è stata statisticamente significativa. In nessun caso si sono verificate complicanze locali sia durante che dopo il trattamento. Solamente in un paziente trattato con radiofrequenza (1/9, 11%) abbiamo riscontrato nei 6 giorni successivi al trattamento insorgenza di febbricola e malessere generale compatibile con la “sindrome post-radiofrequenza”, risoltasi poi al settimo giorno e trattata solo con acetaminofene (paracetamolo).

Conclusioni

Le tecniche ablative percutanee rappresentano una sicura e valida alternativa al trattamento del dolore localizzato da metastasi ossee singole, apportando in breve tempo (4 settimane) un miglioramento della sintomatologia e una sensibile riduzione delle dosi di morfina. Ciò concorre a migliorare la qualità della vita in pazienti affetti da malattia metastatica.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Scutellari PN, Antinolfi G, Galeotti R, Giganti M (2003) La malattia ossea metastatica. Strategia della diagnostica per immagini. Minerva Med 94:77–90

    PubMed  CAS  Google Scholar 

  2. Callstrom MR, Charboneau JW, Goetz MP et al (2006) Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol 35:1–15

    Article  PubMed  Google Scholar 

  3. Agarawal JP, Swangsilpa T, Van Der Liden Y et al (2006) The role of external beam radiotherapy in the management of bone metastases. Clinical Oncology 18:747–760

    Article  PubMed  CAS  Google Scholar 

  4. Gangi A, Kastler B, Klinkert A, Dietermann JL (1994) Injection of alcohol into bone metastases under CT guidance. J Comput Assist Tomogr 18:932–935

    Article  PubMed  CAS  Google Scholar 

  5. Kojima H, Tanigawa N, Kariya S et al (2006) Clinical assessment of percutanoeus radiofrequency ablation for painful metastsatic bone tumors. Cardiovasc Intervent Radiol 29:1022–1026

    Article  PubMed  Google Scholar 

  6. Toyota N, Naito A, Kakizawa H et al (2005) Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol 28:578–583

    Article  PubMed  Google Scholar 

  7. Kelekis A, Lovblad KO, Mehidzade A et al (2005) Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol 16:81–88

    PubMed  Google Scholar 

  8. Hierholzer J, Anselmetti G, Fuchs H et al (2003) Percotaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur. J Vasc Interv Radiol 14:773–777

    PubMed  Google Scholar 

  9. Dupuy DE, Hong R, Oliver B, Goldberg SN (2000) Raddiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. AJR Am J Roentgenol 175:1263–1266

    PubMed  CAS  Google Scholar 

  10. Simon CJ, Dupuy DE, William W (2005) Microwave ablation: principles and applications. Radiographics 25:69–83

    Article  Google Scholar 

  11. Callstrom MR, Charboneau JW (2007). Image-guided palliation of painful metastases using percutaneous ablation. Tech Vasc Interv Radiol 10:120–131

    Article  PubMed  Google Scholar 

  12. Carrafiello G, Laganà D, Ianniello A et al (2007) Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumors: one centre experience and review of published works. Australas Radiol 51:550–554

    Article  PubMed  CAS  Google Scholar 

  13. Guaraldi M, Martoni A (2005) Metastasi ossee. In: Lopez M (ed) Oncologia medica pratica. Società editrice universitaria, Roma, pp 2131–2137

    Google Scholar 

  14. Ditonno P, Battaglia M, Selvaggi FP (2003) Tumori dell’apparato urogenitale. In: Schena FP, Selvaggi FP (eds) Malattie dei reni e delle vie urinarie. McGraw-Hill ed, Milano, pp 487–540

    Google Scholar 

  15. Pecorelli S, Sartori E, Palai N (2000) Tumori mammari. In: Grella PV, Massobrio M, Pecorelli S, Zichella L (eds) Compendio di ginecologia e ostetricia. Monduzzi Ed, Bologna, pp 381–408

    Google Scholar 

  16. Frassica FJ, Frassica DA, Lietman SA et al (2001) Metastatic bone disease. In: Chapman’s (ed) Orthopaedic surgery. Lippincott Williams & Wilkins ed, Philadelphia, pp 3469–3481

    Google Scholar 

  17. Yazawa Y, Frassica FJ, Chao EY et al (1990) Metastatic bone disease: a study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop 251:213–219

    PubMed  Google Scholar 

  18. Wunderlich T, Blumlein H, Steeger D (1980) Tumor prothesis in the treatment of metastases, loosening of prothesis and fractures at the proximal femur. Z Orthop Ihre Grenzgeb 118:61–65

    Article  PubMed  CAS  Google Scholar 

  19. Tordiglione M, Luraghi R, Antognoni P (1999) Il ruolo della radioterapia palliativa e sintomatica delle metastasi ossee. Radiol Med 97:372–377

    PubMed  CAS  Google Scholar 

  20. Lin A, Ray ME (2006) Targeted and systemic radiotherapy in the treatment of bone metastasis. Cancer Metastasis Rev 25:669–675

    Article  PubMed  Google Scholar 

  21. Wolrd Healt Organization (1990) Cancer pain relief and palliative care: report of a WHO expert committee. World Healt Organization, Geneve

    Google Scholar 

  22. Simon JC, Dupuy DE (2005) Image-guided ablative techniques in pelvic malignancies: radiofrequency ablation, cryoablation, microwave ablation. Surg Oncol Clin N Am 14:419–431

    Article  PubMed  Google Scholar 

  23. Simon JC, Dupuy DE (2006) Percutaneous minimally invasive therapies in the treatment of bone tumors: thermal ablation. Semin Muscoloskelet Radiol 10:137–144

    Article  Google Scholar 

  24. Buy X, Basile A, Bierry G et al (2006) Saline-infused bipolar radiofrequency ablation of high-risk spinal and paraspinal neoplasms. AJR Am J Roentgenol 186:322–326

    Article  Google Scholar 

  25. Georgy BA, Wong W (2007) Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures. Am J Neuroradiol 28:700–705

    PubMed  CAS  Google Scholar 

  26. Mannion RJ, Wolf CJ (2000) Pain mechanisms and management: a central perspective. Clin J Pain 16:144–156

    Article  Google Scholar 

  27. Honore P, Luger NM, Sabino MA et al (2000) Osteoprotegerin blocks bone cancer-induced skeletal destruction, skeletal pain and pain-related neurochemical reorganization of the spinal cord. Nat Med 6:521–528

    Article  PubMed  CAS  Google Scholar 

  28. Callstrom MR, Charboneau JW, Goetz MP et al (2002) Painful metastases involving bone: feasibility of percutaneous CT- and US- guided radio-frequency ablation. Radiology 224:87–97

    Article  PubMed  Google Scholar 

  29. Goetz MP, Callstrom MP, Charboneau W et al (2004) Percutaneous imageguided radiofrequncy ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 22:303–306

    Google Scholar 

  30. Masala S, Manenti G, Roselli M et al (2007) Percutaneous combined therapy for painful sternal metastases: a radiofrequency thermal ablation (RFTA) and cementoplasty protocol. Anticancer Res 27:4259–4262

    PubMed  Google Scholar 

  31. Carrafiello G, Laganà D, Recaldini C et al (2007) Combined treatment of ablative therapy with percutaneous radiofrequency and cementoplasty of a symptomatic metatstatic lesion of the acetabulum: case report. Australas Radiol 51(Suppl B): 344–348

    Google Scholar 

  32. Nakatsuka A, Yamakado K, Maeda M et al. (2004) Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 15:707–712

    PubMed  Google Scholar 

  33. Hoffmann RT, Jakobs TF, Trumm C et al (2008) Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. J Vasc Interv Radiol 19:419–425

    Article  PubMed  Google Scholar 

  34. Schaefer O, Lohrmann C, Markmiller M et al (2003) Combined treatment of a spinal metastasis with radiofrequency heat ablation and vertebroplasty. AJR Am J Roentgenol 180:1075–1077

    PubMed  Google Scholar 

  35. Basile A, Giuliano G, Scuderi V et al (2008) Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med 113:1018–1028

    Article  PubMed  CAS  Google Scholar 

  36. Caudana R, Renzi Brivio L, Ventura L et al (2008) CT-guided percutaneous verteboplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases. Radiol Med 113:114–133

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cattedra di Radiologia, Ospedale di Circolo di Varese, Università degli Studi dell’Insubria, Viale Borri 57, 21100, Varese, Italy

    G. Carrafiello, D. Laganà, C. Pellegrino, F. Fontana, M. Mangini, P. Nicotera, M. Petullà, E. Bracchi, E. Genovese, S. Cuffari & C. Fugazzola

Authors
  1. G. Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Laganà
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Pellegrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Fontana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Mangini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Nicotera
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Petullà
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Bracchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Genovese
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Cuffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Fugazzola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Carrafiello.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carrafiello, G., Laganà, D., Pellegrino, C. et al. Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience. Radiol med 114, 608–625 (2009). https://doi.org/10.1007/s11547-009-0395-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-009-0395-5

Keywords

Parole chiave

Search

Navigation