Bone and Soft Tissue Ablation

Abstract

Bone and soft tissue tumor ablation has reached widespread acceptance in the locoregional treatment of various benign and malignant musculoskeletal (MSK) lesions. Many principles of ablation learned elsewhere in the body are easily adapted to the MSK system, particularly the various technical aspects of probe/antenna design, tumoricidal effects, selection of image guidance, and methods to reduce complications. Despite the common use of thermal and chemical ablation procedures in bone and soft tissues, there are few large clinical series that show longitudinal benefit and cost-effectiveness compared with conventional methods, namely, surgery, external beam radiation, and chemotherapy. Percutaneous radiofrequency ablation of osteoid osteomas has been evaluated the most and is considered a first-line treatment choice for many lesions. Palliation of painful metastatic bone disease with thermal ablation is considered safe and has been shown to reduce pain and analgesic use while improving quality of life for cancer patients. Procedure-related complications are rare and are typically easily managed. Similar to all interventional procedures, bone and soft tissue lesions require an integrated approach to disease management to determine the optimum type of and timing for ablation techniques within the context of the patient care plan.

Bone Pain and Muscle Weakness in Cancer Patients

“…A total of 1400–2600J energy delivered over 60–90 minutes has yielded 30–45% reductions in CIBP without complications. [84]…”

Analysis of tissue changes, measurement system effects, and motion artifacts in echo decorrelation imaging

“…Echo decorrelation imaging has been proposed as a method for monitoring of radiofrequency ablation (RFA), a currently important clinical treatment modality for unresectable liver cancer [3][4][5] and other tumors of soft tissue and bone. 6,7 Echo decorrelation imaging may also be applicable to monitoring of other thermal ablation methods, [8][9][10] including high-intensity focused ultrasound ablation. [11][12][13] Preliminary research has confirmed the ability of echo decorrelation imaging to predict heat-induced tissue coagulation for RFA and ultrasound ablation, both in vitro 1,14 and in vivo.…”

Real‐time probe tracking using EM‐optical sensor for MRI‐guided cryoablation

“…In addition to the targeting error, the size of the tumor is another factor that clinicians should take into consideration prior to cryoablation. It has been advised that the probe must be placed approximately 1 cm from the tumor margins and 2 cm from each other . MRI‐guided cryoablation is recommended to treat larger lesions: its main advantage of precise visualization of the ablation zone ensures coverage of the total tumor while sparing neighboring healthy structures.…”

“…It has been advised that the probe must be placed approximately 1 cm from the tumor margins and 2 cm from each other. 38,39 MRI-guided cryoablation is recommended to treat larger lesions: its main advantage of precise visualization of the ablation zone ensures coverage of the total tumor while sparing neighboring healthy structures. The proposed probe tracking method integrated with preprocedural MRI can be used to guide probe intervention.…”