Percutaneous radiofrequency ablation in painful bone metastases
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Published:
Sep 11, 2015
Keywords:
metastases, painful bone metastasis, ablation, radiofrequency, CT.
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Abstract
BackgraundThere are different treatment for painful bone metastases (mtts), with different results. CT-guided Percutaneous Radiofrequency Ablation (CT-PRA) is one of them. The pupose of this retrospective study was to assess the initial results using this methods, focusing on pain relief, showing details of the surgical technique.Methods18 patients with an average age of 59.2 years and 15 months follow-up were treated. Nine mtts were located in the femur, 4 dorsal / lumbar spine, 3 in scapula and 2 in Iliac. The Mtts origin were Breast Ca 7 cases, lung in 4, Kidney in 4 and 3 in Thyroid. The rachis mtts were found at more than 10mm of the medullary cavity and mtts of long bones showed low risk of fracture. Lesions >3cm were treated whit CT-PRA using Valleylab Rita needle and these <3cm with CoolTip needle. Pain was assessed by Visual Analog Scale (VAS) preoperatively, at 2, 7 and 30 days, and then at 3 and 6 months.ResultsPreoperative pain score was 8.33 on average. At 7 days of ablatión de VAS score was 5 on average and at 30 days was 2 points. After at 3 and 6 months de VAS average was 1. This method had excellent patients tolerance and no complications. There were two recurrences which underwent endoprosthesis unconventional proximal femur and knee respectively, evolving favorably.ConclusionCT-guided APRF impresses a promising, simple and effective tool in the treatment of painfull bone mtts, achieving excellent pain control with good tolerance by the patient.
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Sola, G., Fita, I., Sarmiento, P., Garabano, G., & del Sel, H. (2015). Percutaneous radiofrequency ablation in painful bone metastases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(3), 164-170. https://doi.org/10.15417/373
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Clinical Research
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20. Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Atwell TD, Farrell, et al. Image-guided ablation of painful metastatic bone
tumors: a new and effective approach to a difficult problem. Skeletal Radiol 2006;35(1):1–15.
21. Sherif GN, Aschoff AJ, Mitchell IC, Emancipator SN, Duerk JL, Lewin JS. MR imaging-guided radiofrequency thermal ablation
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neoplasms. Am J Roentgenol 2006;186:322–6.
2. Dupuy DE, Goldberg SN. Image-guide radiofrequency tumour ablation: challenges and opportunities. J Vasc Interv Radiol
2001;12:1135-48.
3. Mercadante S. Malignant bone pain: Pathophysiology and treatment. Pain 1997;69:1-18.
4. Di Francesco A, Flamini S, Zugaro L, Zoccali C. Preoperative radiofrequency ablation in painful osteolytic long bone metastases.
Acta Orthop Belg 2012;78:523-30.
5. Thanos L, Mylona S, Galani P, Tzavoulis D, Pomoni M. Radiofrequency ablation of osseous metastases for the palliation of
pain. Skeletal Radiol 2008;37:189-94.
6. Moser T, Goyault G, Gangi A. Image-guided ablation of bone tumors: review of current techniques. J Radiol 2008;89:461-70.
7. Link TM, de Mayo R, O`Donnell RJ. Radiofrequency ablation–an alternative for definitive treatment of solitary bone metastases.
Eur Radiol 2007;17:3012-3.
8. Pagelopoulos PJ, Mavrogenis AF, Galanis EC, Kelekis NL, Wenger DE, Sim FH, et al. Minimally invasive techniques in
orthopedic oncology: radiofrequency and laser thermal ablation. Orthopedics 2005;28(6):563-8.
9. Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous
metastases: a multicenter American College Of Radiology Imaging Network trial. Cancer 2010;116:989-97.
10. Gazelle GS, Goldberg SN, Solbiati L. Tumor ablation with radio-frequency energy. Radiology 2000;217:433-66.
11. Rosenthal DJ, Hornicek FJ, Torriani M. Osteoid osteoma: percutaneous treatment with radio-frequency energy. Radiology
2003;229:171-5.
12. Goetz MP, Callstrom MR, Charboneau JW, Farrel MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency
ablation of painful metastases involving bone: a multicenter study. Clin Oncol 2004;22:300-6.
13. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin
Orthop Relat Res 1989;249:256-64.
14. Frassica DA. General principles of external beam radiation therapy for skeletal metatases. Clin Orthop Relat Res 2003;415:158-64.
15. Marchal F, Brunaud L, Bazin Ch, Boccacini H, Henrot P, Trofleau P, et al. Radiofrequency ablation in palliative supportive care:
early clinical experience. Oncology Reports 2006;15:495-9.
16. Bauman G, Charette M, Reid R, Sathya J. Radiopharmaceuticals for the palliation of painful bone metastasis—a systemic
review. Radiother Oncol 2005;75(3):258–70.
17. Mannion RJ, Woolf CJ. Pain mechanism and management: a central perspective. Clin J Pain 2000;16:144-56.
18. Honore P, Luger NM, Sabino MAC. Osteoprotegerin blocks bone cancer-induced skeletal destruction, skeletal pain and painrelated
neurochemical reorganization of spinal cord. Nat Med 2000;6:521-8.
19. Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Wong GY, Sloan JA, et al. Painful metastases involving bone: feasibility of
percutaneous CT and US guided radiofrequency ablation. Radiology 2002;224:87-97.
20. Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Atwell TD, Farrell, et al. Image-guided ablation of painful metastatic bone
tumors: a new and effective approach to a difficult problem. Skeletal Radiol 2006;35(1):1–15.
21. Sherif GN, Aschoff AJ, Mitchell IC, Emancipator SN, Duerk JL, Lewin JS. MR imaging-guided radiofrequency thermal ablation
of the lumbar vertebrae in porcine models. Radiology 2002;224:452–62.
22. Dupuy DE, Hong R, Oliver BS, Goldberg SN. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal
canal. Am J Roentgenol 2000;175:1263–6.
23. Buy X, Basile A, Bierry G, Cupelli J, Gangi A. Saline-infused bipolar radiofrequency ablation of high-risk spinal and paraspinal
neoplasms. Am J Roentgenol 2006;186:322–6.