CT-guided radiofrequency ablation in osteoid osteoma: Result from a tertiary cancer centre in India

Abstract

Aims:The aim of this study is to evaluate the clinical efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma.Materials and Methods:This is a retrospective analysis of prospectively maintained data of 43 symptomatic osteoid osteoma patients who were treated by radiofrequency ablation (RFA). Forty out of 43 patients were naive cases and underwent primary treatment for osteoid osteoma with RFA, whereas 3 patients included in the study underwent RFA for local recurrence after having undergone surgical treatment. Diagnosis was based on clinical and characteristic imaging findings, and biopsy was done for cases with atypical presentation. Pre and post procedure Visual Analog Score (VAS) was documented in all cases. Monopolar RFA system was used in all patients, and the electrode was placed within the lesion nidus under CT guidance coaxially through 11G introducer needle. Ablation was performed at 90° C for 5 min.Results:Technical success rate of intranidal placement of electrode was 100%. The primary clinical success in our study was 97.7% (42 of 43), and the secondary clinical success was 100%. Pre and postprocedure VAS score in our study group was 7.8 and 0.4, respectively. Mean follow-up period in our study was 48 months (Range: 4–129 months). One patient had recurrence of pain 4 years after treatment and was treated successfully by a second session. Minor complications were seen in 3 patients with two cases of RF pad burns and one case of skin burn at the treatment site, and these were managed conservatively. No patients developed temporary/permanent neurological deficits, and no procedure-related mortality was seen in our study.Conclusion:CT-guided percutaneous RFA is a simple, safe, minimally invasive, and highly effective treatment option for osteoid osteoma with good long-term pain control and potentially low disease recurrence.

Imaging-guided radiofrequency ablation of osteoid osteoma in typical and atypical sites: Long term follow up

“…This could explain why many patients reported a long course of disease at their first survey, with up to 8-month period of continuing pain before having a correct diagnosis. Similar observations have already been proposed [ 18 , 24 ]. Our results clearly correlate the pain suffered by patients affected by OO with age, lesion size at baseline and lesion location (atypical site > typical site): elderly patients and patients with bigger and/or atypically located OO complained of stronger pain.…”

“…Our technical and clinical success were comparable to those assessed in previous published studies, ranging from 91–95% [ 3 , 12 , 18 , 19 ]. In particular, Kulkarni et al [ 18 ] recorded a technical success rate of 100%, with a primary and secondary clinical success rate of 97.7%, and 100%, respectively. Rehnitz et al [ 19 ] reported primary and secondary success rates of 96.1% and 100%, respectively.…”

“…Our result about pain modification is also illustrated in Fig 3 , showing that in our study population the most significant reduction of pain was observed within the first period of follow up. This is quite common in previous published papers about this topic [ 18 , 19 , 24 , 25 ], which describe a drop of pain intensity in the first two weeks after RFA treatment.…”

“…Indeed, many studies have investigated the technical success of the treatment of technically challenging located OOs [ 18 , 24 , 27 – 32 ]. Our study shows that image-guided thermal ablation is also well suited for atypically located OO ( Figs 4 and 5 ) and is overall a safe procedure.…”

Computed tomography guided radio-frequency ablation of osteoid osteomas in atypical locations

“…RFA of OOs has been extensively reported in the past[19202122] with success rates approaching 100%. The key to successful treatment of OOs is complete removal or destruction of the tumor nidus.…”