Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation.
OBJECTIVE
To determine the safety and efficacy of radio-frequency (RF) ablation for pain reduction, quality of life improvement, and analgesics use reduction in patients with skeletal metastases.


METHODS
Over 10 months, 12 adult patients with a single painful osteolytic metastasis in whom radiation therapy or chemotherapy had failed and who reported severe pain (pain score > or = 4 [scale of 0-10]) over a 24-hour period were treated with percutaneous imaging-guided RF ablation with a multi-tined electrode while under general anesthesia. Patient pain was measured with a Brief Pain Inventory 1 day after the procedure, every week for 1 month, and thereafter every other week (total follow-up, 6 months). Patient analgesics use was also recorded at these follow-up intervals. Follow-up contrast material-enhanced computed tomography was performed 1 week after the procedure. Complications were monitored. Analysis of the primary end point was undertaken with paired comparison procedures.


RESULTS
Lesion size was 1-11 cm. Before RF ablation, mean worst pain score in a 24-hour period in 12 patients was 8.0 (range, 6-10). At 4 weeks after treatment, mean worst pain decreased to 3.1 (P =.001). Mean pain before treatment was 6.5 and decreased to 1.8 (P <.001) 4 weeks after treatment. Mean pain interference in general activity decreased from 6.6 to 2.7 (P =.002) 4 weeks after treatment. Eight of 10 patients using analgesics reported reduced use at some time after RF ablation. No serious complications were observed.


CONCLUSIONS
RF ablation of painful osteolytic metastases is safe, and the relief of pain is substantial.
Callstrom
Matthew R
MR
Department of Radiology, Mayo Clinic, 200 First St SW, E2, Rochester, MN 55905, USA.
Charboneau
J William
JW
Goetz
Matthew P
MP
Rubin
Joseph
J
Wong
Gilbert Y
GY
Sloan
Jeff A
JA
Novotny
Paul J
PJ
Lewis
Bradley D
BD
Welch
Timothy J
TJ
Farrell
Michael A
MA
Maus
Timothy P
TP
Lee
Robert A
RA
Reading
Carl C
CC
Petersen
Ivy A
IA
Pickett
Deitra D
DD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012449:Safety; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000700:Analgesics