Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients

Abstract

Introduction: Percutaneous image-guided cryo-(CA) and radiofrequency-(RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. Materials and Methods: This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. Results: Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N ¼ 37; 75,5%) or RFA (N ¼ 12; 24,5%). Primary malignancies included thyroid (N ¼ 11, 22.5%), breast (N ¼ 21; 42.9%), lung (N ¼ 8; 16.3%) and other (N ¼ 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N ¼ 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N ¼ 14); 1-and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p ¼ .002). Conclusions: Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM 2 cm.

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

“…3 Advantages also include suitability for real-time imaging guidance and the ability to perform ablative procedures on outpatient/day-case settings. 41 In addition, percutaneous ablation, when compared with other nonpercutaneous (noninvasive) ablation treatments such as radiotherapy and magnetic resonance-guided high-intensity focused ultrasound (MRg-HIFU), offers the benefits of combining bone consolidation with ablation within the same intervention, thus significantly reducing the risk of secondary fracture. 41 Secondary gains include reduction in pain levels via local destruction of pain-sensitive nerves as well as reducing the production of cytokines and growth factors produced following tumor necrosis, disruption of internal cellular membranes, and/or coagulation of its cellular proteins.…”

French Multidisciplinary Approach for the Treatment of MSK Tumors

“…2,4 A few other cohorts of patients may be referred to get the best therapy with the best local tumor control; generally, these patients are those presenting with (1) an oligometastatic status (i.e., fewer than three metastases regardless of the metastatic site, size < 2-3 cm); (2) an oligo-progressive metastatic disease (i.e., patients with one or few bone metastases evolving under systemic therapies despite an overall stable and controlled systemic multimetastatic disease); or (3) an impending complication that may complicate untreated bone metastasis (e.g., metastasis of the posterior third of the vertebral body that may result in a spinal cord compression). 2,69,70 The armamentarium of local treatments include surgery, radiation therapy, and interventional techniques (i.e., ablation, embolization, osteoplasty, and osteosynthesis). These treatments may be applied as stand-alone therapies, or, more commonly, they are modulated sequentially with a synergic effect according to the palliative/curative principle.…”

“…84 Despite the curative or palliative intent, percutaneous ablation may be coupled to percutaneous bone consolidation in the same interventional session through osteoplasty or osteosynthesis. 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.…”

Percutaneous image-guided thermal ablation of bone metastases: a retrospective propensity study comparing the safety profile of radio-frequency ablation and cryo-ablation

“…The decision to perform TA was established following discussion in a multidisciplinary tumor board meeting including oncologists, orthopedic surgeons, anesthesiologists and interventional radiologists. Patients were referred for consideration of percutaneous TA if they required either a palliative treatment due to painful BM not previously treated with, or refractory to standard treatments (including analgesics and radiotherapy [RT]); either a curative treatment due to an oligometastatic (<3 metastases with tumors size 3 cm) or oligoprogressive disease (1-2 metastases not responding to systemic therapy despite an overall stable systemic disease) [9,10].…”

“…In the last few decades, the therapeutic armamentarium for BM has broadened to include percutaneous thermal ablation (TA) techniques, available to the multidisciplinary tumor board to provide palliative or curative treatment. Radiofrequency ablation (RFA) and cryoablation (CA) [4][5][6][7] are the two most commonly used and investigated techniques, and share comparable effective clinical results in the palliative [4,5,8,9], and curative [9,10] setting. Moreover, the safety of RFA and CA has been proven, with series reporting rates of overall/major complication of 16%/5% and 9.1%/ 2.5%, respectively [11][12][13][14][15].…”