Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients

Abstract

Background To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population. Materials and methods A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months. Results A total of 11 patients were included (mean 14 years, age range 9–17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2–L3 transient radiculopathy as major immediate complication. Conclusions Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.

Introduction to interventional oncology: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

“…A report documenting the technical and clinical success of cryoablation to treat pediatric chondroblastoma tumors showed 100% success in both technical (full coverage of the targeted bone lesion with ice ball) and clinical (cessation of pain) parameters. 32 Additionally, there were no signs or symptoms of local tumor recurrence after cryoablation in this patient cohort.…”

“…Unfortunately, the patient treated with cryoablation succumbed to widespread metastatic involvement within 1 month of the ablation procedure, and long‐term follow‐up was not possible. A report documenting the technical and clinical success of cryoablation to treat pediatric chondroblastoma tumors showed 100% success in both technical (full coverage of the targeted bone lesion with ice ball) and clinical (cessation of pain) parameters 32 . Additionally, there were no signs or symptoms of local tumor recurrence after cryoablation in this patient cohort.…”

Chondroblastoma Affecting the Apophysis of the Greater Trochanter in a Child

“…Radiofrequency ablation has also been used as a primary treatment of chondroblastoma but the mechanical failure of weight-bearing articular surfaces is possible as well as thermal damage of uninvolved compartments of the joint [12]. Cryosurgery, too, has been used, both as an adjuvant to intralesional curettage (liquid nitrogen) and as a standalone procedure (percutaneous cryoablation), in the treatment of chondroblastoma [5,13].…”

“…In spite of its benign histological nature, metastases to the lungs, bones, and soft tissues have been reported [3]. Open surgery is the principal treatment modality but curative percutaneous radiofrequency thermoablation or cryoablation has also been reported [4,5]. Rarely, in multiple recurrences or malignant transformation, amputation could be considered [3].…”