Complications of Percutaneous Bone Tumor Cryoablation: A 10-year Experience

Abstract

Background: Percutaneous cryoablation has been shown to be effective in the management of painful bone tumors. However, knowledge of the complication rate and risk factors for complication is currently lacking. Purpose:To report the complication rate and associated risk factors for bone tumor cryoablation. Materials and Methods:This retrospective study reviewed complications in 239 consecutive patients (131 men and 108 women; median age, 64 years; age range, 6-86 years) who underwent cryoablation of 320 primary or metastatic bone tumors between January 2008 and November 2017. Common Terminology Criteria for Adverse Events was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Multivariable analysis was performed for variables with P values less than .20, including age, tumor location, adjacent critical structures, number of cryoprobes, and Eastern Cooperative Oncology Group performance status (ECOG-PS).Results: Among the 320 tumors, the total complication rate was 9.1% (29 of 320; 95% confidence interval [CI]: 6%, 12.2%). The major complication rate was 2.5% (eight of 320; 95% CI: 0.8%, 4.2%), with secondary fracture the most frequent complication (1.2% [four of 320]; mean delay, 71 days); cryoablation site infection, tumor seeding, bleeding, and severe hypotension were each observed in 0.3% (one of 320) of procedures. Minor complications included postprocedural pain (2.2% [seven of 320]), peripheral neuropathy (0.9% [three of 320]), and temporary paresthesia (0.9% [three of 320]). For all complications, associated risk factors included ECOG-PS greater than 2 (odds ratio [OR], 3.1 [95% CI: 3, 7.6]; P = .01), long-bone cryoablation (OR, 17.8 [95% CI: 2.3, 136.3]; P = .01), and use of more than three cryoprobes (OR, 2.5 [95% CI: 1.0, 6.0]; P = .04); for major complications, associated risk factors included age greater than 70 years (OR, 7.1 [95% CI: 1.6, 31.7]; P = .01) and use of more than three cryoprobes (OR, 23.6 [95% CI: 2.8, 199.0]; P = .01). Conclusion:Bone tumor cryoablation is safe, with a 2.5% rate of major complications, most commonly secondary fracture (1.2%). Major complications are associated with age greater than 70 years and use of more than three cryoprobes.

Cryoablation of Extra-Abdominal Desmoid Tumors: A Single-Center Experience with Literature Review

“…CA of EAD tumors can be challenging due to the proximity of vital anatomical structures or their size; in most cases of DTs in the extremities, the lesion can be in direct contact with important nerves. Nevertheless, complication rates in the literature are low, ranging between 9.1% and 11.1% [ 31 , 32 ]. We faced two major complications, including that, in three cases, the distance between the DT and a major nerve was <1 cm.…”

French Multidisciplinary Approach for the Treatment of MSK Tumors

“…69,85,86 This approach is applied because secondary bone insufficiency fractures represent the most common major complication occurring after thermal treatments. 87 Therefore, bone consolidation is always proposed along with percutaneous ablation (►Fig. 5), which represents the most practical advantage of percutaneous thermal treatments over radiation therapy.…”

Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?

“…Importantly, this precise neural injury results in several welldescribed events that may lead to favorable clinical outcomescessation of conduction, 48 induced Wallerian degeneration, and predictable regeneration of axons upon an intact connective tissue scaffold. 2,44,49 The translation of these events (beyond conduction cessation) has been documented as nerve function recovery in animal studies and in humans [50][51][52][53][54] -which may have implications for interventional radiologists as neuroregenerative inductive therapies (►Fig. 6).…”