Safety and Feasibility of Steerable Radiofrequency Ablation in Combination with Cementoplasty for the Treatment of Large Extraspinal Bone Metastases

Abstract

Background: Radiofrequency ablation (RFA) and cementoplasty, individually and in concert, has been adopted as palliative interventional strategies to reduce pain caused by bone metastases and prevent skeletal related events. We aim to evaluate the feasibility and safety of a steerable RFA device with an articulating bipolar extensible electrode for the treatment of extraspinal bone metastases. Methods: All data were retrospectively reviewed. All the ablation procedures were performed using a steerable RFA device (STAR, Merit Medical Systems, Inc., South Jordan, UT, USA). The pain was assessed with a VAS score before treatment and at 1-week and 3-, 6-, and 12-month follow-up. The Functional Mobility Scale (FMS) was recorded preoperatively and 1 month after the treatment through a four-point scale (4, bedridden; 3, use of wheelchair; 2, limited painful ambulation; 1, normal ambulation). Technical success was defined as successful intraoperative ablation and cementoplasty without major complications. Results: A statistically significant reduction of the median VAS score before treatment and 1 week after RFA and cementoplasty was observed (p < 0.001). A total of 6/7 patients who used a wheelchair reported normal ambulation 1 month after treatment. All patients with limited painful ambulation reported normal ambulation after the RFA and cementoplasty (p = 0.003). Technical success was achieved in all the combined procedures. Two cement leakages were reported. No local recurrences were observed after 1 year. Conclusions: The combined treatment of RFA with a steerable device and cementoplasty is a safe, feasible, and promising clinical option for the management of painful bone metastases, challenging for morphology and location, resulting in an improvement of the quality of life of patients.

Clinical Rationale of Using Steerable Technologies for Radiofrequency Ablation Followed by Cavity Creation and Cement Augmentation in the Treatment of Painful Spinal Metastases

“…The low compliance balloon resulted in the maintenance of the predetermined shape in sclerotic lesions as well, with the ability to optimally apply load for tissue ablated displacement with the goal of optimal cavity creation. In terms of pain relief and local tumor control, the results are in line with our previous studies [ 8 , 9 ]; the addition of void creation with steerable balloons appears to be a safe technique to reduce cement overflow and achieve precise cement filling.…”

“…In our experience, technological advances have changed our clinical practice with the adoption of radiofrequency ablation for bone metastases with steerable bipolar probes and embedded thermocouples, allowing precise ablation and real-time feedback to quantify, adjust, and confirm the ablation zone intraoperatively [ 8 , 9 ]. Steerability in bone tumors plays a key role in overcoming suboptimal anatomy and accesses, performing adequate ablation of posterior lesions through a transpedicular approach and allowing overlapping zones through the same access.…”

“…In our past retrospective clinical trials, the benefit of the steerable radiofrequency ablation probe in combination with vertebral augmentation in the treatment of hard-to-reach bone metastases has been demonstrated to achieve local tumor control with immediate and lasting pain relief [ 8 , 9 ].…”

Percutaneous CT-Guided Microwave Ablation Combined with Pedicle Screw Fixation Followed by Vertebroplasty (MASFVA): Initial Experience of a Minimally Invasive Treatment of Vertebral Metastases with Extension to the Vertebral Pedicle

“…In a previous study, we have already evaluated as effective and safe the use of combined treatment of radiofrequency ablation with a steerable device and vertebroplasty for the management of painful bone metastases, resulting in improved patient quality of life [18].…”

Surgical robot-assisted tripod percutaneous reconstruction technique combined with bone cement filling technique for the treatment of acetabular metastasis

“…Bone cement was disseminated into tumor blood vessels and solidified, blocking tumor blood vessels. The bone cement surrounded the lesion and blocked the further invasion of the lesion (Pusceddu et al, 2022). Zhang et al (2020) proposed that augmented cementoplasty has several advantages, including the minimization of surgical morbidity, shorter hospital stays, and lower healthcare costs.…”