Successful Management Of Tumor‐Induced Osteomalacia with Radiofrequency Ablation: A Case Series

Abstract

Tumor‐induced osteomalacia (TIO) is a curable condition when the tumor is correctly located and completely removed. These tumors are, however, small and located in regions that make surgical removal difficult and sometimes risky in some patients. Experience of radiofrequency ablation (RFA) in the management of TIO is limited. We describe 3 patients with TIO who were treated in our hospital with RFA. They had suspected lesions in surgically difficult locations and were subjected to single sessions of RFA. The response was documented in terms of improvement in symptoms, normalization of hypophosphatemia and hyperphosphaturia, and disappearance of uptake on follow‐up Ga 68 DOTANOC PET/CT imaging. All 3 patients had a clinical and biochemical profile consistent with TIO. The first patient (patient 1) had an intensely Ga 68 DOTANOC avid lesion involving the roof of right acetabulum. The second patient (patient 2) had a Ga 68 DOTANOC avid intramuscular lesion in left pectineus muscle and the third patient (patient 3) had a Ga 68 DOTANOC avid expansile osteolytic lesion involving the angle and ramus of right mandible. All 3 patients achieved complete biochemical as well as clinical remission with single sessions of RFA. Six months after the procedure, Ga 68 DOTANOC imaging revealed the absence of uptake at the previous sites, corroborating with the clinical improvement and normalization of hypophosphatemia and hyperphosphaturia. In conclusion, although surgical resection is the standard of care, RFA can be used successfully for treating patients with TIO. It can be an effective, less invasive, and safe modality of treatment in those patients where resection of the lesion is not possible because of inaccessible anatomical location or comorbidity that prohibits surgery. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Diagnosis and Management of Tumor-induced Osteomalacia: Perspectives From Clinical Experience

“…When a localized tumor is not amenable to definitive resection because of anatomical location or risk of significant morbidity following surgical resection, less invasive modalities such as radiotherapy or CT-guided radiofrequency ablation can be considered. A recent case series showed that CT-guided radiofrequency ablation was effective and well tolerated in patients with TIO [ 52 ], although long-term efficacy is unknown. Radiotherapy has been described in cases of incompletely resected tumors, to avoid recurrence or metastases [ 48 , 53 ].…”

Epidemiology of Tumor-Induced Osteomalacia in Denmark

“…The tumor may secrete other phosphatonins in addition to FGF23. Surgical cure is possible in patients provided the location of the tumor can be accurately identified by imaging [ 2 ] and that the tumor can be reached and removed surgically [ 1 , 3 , 4 ], or through radiofrequency ablation [ 5 ]. Patients with TIO experience a sudden onset pronounced, often debilitating, myopathy of the proximal muscles, resulting at first in muscle pain and in a waddling gait and severe problems climbing stairs or rising from a chair.…”

Tumor-induced osteomalacia caused by head and neck tumors: report of an unusual case and literature review

“…Although complete surgical resection is the standard treatment for patients with TIO, radiofrequency ablation can also be an effective, safe and less invasive alternative for patients with TIO if the anatomical structures are complex, some anatomical sites are difficult to reach, surgery may affect surrounding important structures, or patient conditions are not suitable for surgery (39). When surgery and radiofrequency ablation are not available, external radiotherapy and peptide receptor radiotherapy are also conservative options for management of TIO patients (4) (Table 3).…”