Percutaneous radiofrequency ablation of painful osseous metastases: A multicenter trial: American College of Radiology Imaging Network 6661

Abstract

9101 Background: Radiofrequency Ablation (RFA) can destroy tissue in a defined area. Single institutions have reported that RFA can reduce pain from bone metastases. To confirm this, the American College of Radiology Imaging Network (ACRIN) completed a multicenter study of RFA for bone metastases. Methods: Eligible patients had bone pain in one dominant site: tumor size < 8 cm, and location > 1 cm from the spinal cord or cauda equina. RFA was performed under CT guidance. The Memorial Pain Assessment Card was used prior to RFA and repeated daily for two weeks, and at 1 and 3 months after RFA. AEs were recorded in addition to four different pain assessment measures: pain relief, patient mood, pain intensity, and pain severity. Results: Fifty-six patients had RFA at 9 centers. Metastatic sites were pelvis (24), chest wall (19), thoracolumbar spine (8), and extremities (5). Six out of 56 patients experienced at least one adverse event of grade 3 or higher, yielding an AE rate of 10.7% (95%CI is 2.6% to18.8%). AEs attributed directly to RFA were nerve injury in 2 patients. Of the 56 participants, 43 completed the 1 month follow-up and 33 completed the 3 month follow-up. At the time of this analysis, assuming that missing data were missing at random and after adjusting for all covariates, RFA showed significant effect in reducing pain at 1 and 3 month follow-up for all 4 pain assessment measures. The average increase in pain relief from pre-RFA to 1 month follow-up is 26.4 (P<0.0001) and the increase from pre-RFA to 3 month follow-up is 17.2 (P=0.003). The average increase in mood from pre-RFA to 1 month follow-up is 21.5 (P<0.0001) and the increase from pre-RFA to 3 month follow-up is 16.3 (P=0.001). The average decrease in pain intensity from pre-RFA to 1 month follow-up is 25.9 (P<0.0001) and the decrease from pre-RFA to 3 month follow-up is 13.0 (P=0.02). The odds of being in lower pain severity at 1 month follow-up is 12.6 (P<.0001) times higher than that at pre-RFA, and the odds at 3 month follow-up is 7.1 (P<0.0001) times higher than that at pre- RFA. Conclusions: This cooperative group trial confirms that RFA can safely palliate pain due to bone metastases. ACRIN receives funding from the National Cancer Institute through the grants U01 CA079778 and U01 CA080098. No significant financial relationships to disclose.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…RF ablation of bone lesions has proven successful in pain management, especially for those who do not attain adequate analgesia without intolerable effects. [232][233][234][235] Several small studies have also demonstrated the palliative effects of high-intensity focused ultrasound (HIFU) treatment of bone lesions. [236][237][238] Physical and occupational therapy may also be beneficial in the prevention of complications associated with SREs.…”

“…Ablation therapy (eg, RF ablation, ultrasound ablation) for bone lesions can also be helpful in reducing pain. [232][233][234][235][236][237][238] See "Management Strategies for Specific Cancer Pain Syndromes, Bone Pain Without an Oncologic Emergency" (PAIN-D, page 980) for more information.…”

Review and Uses of Stereotactic Body Radiation Therapy for Oligometastases

“…The patient selection criteria are similar to those using SBRT. RFA is effective in reducing pain resulting from skeletal metastatic disease, as demonstrated in two multicentric trials [60,61], even though the results of the two studies are different because of factors that include patient selection, the level of anesthesia, and the degree of tumor destruction. At the 3-month time point, there was a reduction in pain of 14 points in the American College of Radiology Imaging Network study and of 28 points in the Goetz et al…”

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

“…Percutaneous tumor ablation is recommended for pain palliation when radiation therapy cannot be offered or is incompletely effective (grade C) [12,13,15,34,[48][49][50][51][52][53]. In a retrospective study of 128 radiofrequency-ablated spinal metastases, patients reported a mean preprocedure pain score of 7.51/10 6 2.46 and decreased mean pain scores 1 week (1.73/10 6 2.28; p , .0001), 1 month (2.25/10 6 2.44; p , .0001), and 6 months (1.75/10 6 2.62; p 5 .009) after treatment [15].…”