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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.

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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

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  1. G. Carrafiello
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  2. D. Laganà
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  3. C. Pellegrino
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  4. F. Fontana
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  5. M. Mangini
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  6. P. Nicotera
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  7. M. Petullà
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  8. E. Bracchi
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  9. E. Genovese
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  10. S. Cuffari
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  11. C. Fugazzola
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Correspondence to G. Carrafiello.

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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

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

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