Radiofrequency Ablation Therapy Combined with Cementoplasty for Painful Bone Metastases: Initial Experience

Abstract

The purpose of this study was to assess the efficacy and safety of percutaneous radiofrequency (RF) ablation therapy combined with cementoplasty under computed tomography and fluoroscopic guidance for painful bone metastases. Seventeen adult patients with 23 painful bone metastases underwent RF ablation therapy combined with cementoplasty during a 2-year period. The mean tumor size was 52 x 40 x 59 mm. Initial pain relief, reduction of analgesics, duration of pain relief, recurrence rate of pain, survival rate, and complications were analyzed. The technical success rate was 100%. Initial pain relief was achieved in 100% of patients (n=17). The mean VAS scores dropped from 63 to 24 (p<0.001) (n=8). Analgesic reduction was achieved in 41% (7 out of 17 patients). The mean duration of pain relief was 7.3 months (median: 6 months). Pain recurred in three patients (17.6%) from 2 weeks to 3 months. Eight patients died and 8 patients are still alive (a patient was lost to follow-up). The one-year survival rate was 40% (observation period: 1--30 months). No major complications occurred, but one patient treated with this combined therapy broke his right femur 2 days later. There was transient local pain in most cases, and a hematoma in the psoas muscle (n=1) and a hematoma at the puncture site (n=1) occurred as minor complications. Percutaneous RF ablation therapy combined with cementoplasty for painful bone metastases is effective and safe, in particular, for bulky tumors extending to extraosseous regions. A comparison with cementoplasty or RF ablation alone and their long-term efficacies is needed.

Painful Pathologic Fracture of the Humerus: Percutaneous Osteoplasty With Bone Marrow Nails Under Hybrid Computed Tomography and Fluoroscopic Guidance

“…In the above-mentioned series (8,9), osteoplasty was shown to be safe and effective in the treatment of painful bone metastases refractory to conventional therapy and with no surgical options. Although the complication rate was very low, subsequent recurrence of fractures in long bones suggested that the treatment was inadequate in those cases.…”

“…In such cases, percutaneous osteoplasty (also called cementoplasty) could be performed for stabilization of the fracture. This procedure was previously described (8,9), but results were discouraging because a high rate of delayed fractures of the treated bone shaft was reported. Previously, a case of a pathologic fracture of the humeral shaft was treated by percutaneous osteoplasty with use of a bone cement-filled catheter resulting in pain relief (10).…”

Experiencia preliminar en el tratamiento combinado de metástasis vertebrales mediante radiofrecuencia y cifoplastia en sesión única

“…Desde el punto de vista clínico, los resultados son buenos con mejoría del dolor en las primeras 24 horas en todos los pacientes, resultados similares a los obtenidos por otros autores (8)(9)(10)(11)(12)(13). En lo relativo a los aspectos técnicos, la combinación de ambas técnicas no incrementa la complejidad del procedimiento ya que el acceso transpedicular empleado, para la realización de la cifoplastia, es el mismo que se requiere para la realización de la RF previa, con la excepción de que el acceso óseo inicial para efectuar la ablación se realizó con agujas de 11G, que posteriormente se intercambian por el sistema de acceso de cifoplastia.…”

“…Estudios recientes sugieren que los tratamientos percutáneos, mínimamente invasivos, pueden contribuir al manejo de estos pacientes (3,4,(6)(7)(8)(9)(10)(11)(12)(13).…”

Thermometry during coblation and radiofrequency ablation of vertebral metastases: a cadaver study

“…Concerning pain reduction, the combination of thermal ablation and vertebroplasty shows high success rates, which can be up to 100 % [3]. In general, there are two different thermal ablation methods: radiofrequency ablation (RFA) and radiofrequency ionization (coblation).…”