Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies.
OBJECTIVE
To evaluate the feasibility, safety, and effectiveness of combined treatment with radiofrequency (RF) ablation followed by bone cement injection in patients with malignant bone neoplasms.


METHODS
Seventeen patients with 23 bone tumors were treated. The tumors, measuring 1.2-15 cm (mean, 4.9 +/- 3.5 cm), were located in the spine (n = 17), iliac bone (n = 3), sacrum (n = 2), and ischial bone (n = 1). All procedures were performed with computed tomographic (CT) fluoroscopic guidance. An electrode with an internally cooled tip was placed in the bone tumor through a biopsy needle and RF energy was applied, followed by cement injection. Pain relief was evaluated with use of the visual analogue scale score (VAS score). Local therapeutic effects were evaluated by contrast-enhanced MR imaging. Lack of tumor enhancement was considered to indicate necrosis.


RESULTS
The procedures were technically successful in all patients except for one patient with an osteoblastic ischial lesion (22 of 23 patients; 96%). Pain was relieved within 1 week in all 13 patients who reported pain (13 of 13 patients; 100%), with a significant decrease in the VAS score from 8.4 to 1.1 (P <.001). Tumor necrosis was observed in 71% +/- 24% of the tumor volume (range, 14%-100%). Neural damage occurred in four patients in whom the tumor had invaded the posterior cortex of the vertebral body and pedicle.


CONCLUSIONS
The combined therapy described here is both feasible and useful for the treatment of malignant bone neoplasms. The safety of the procedure depends on the tumor location. When the tumor is adjacent to the spinal cord, there is a risk of nerve injury.
Nakatsuka
Atsuhiro
A
Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. nakatuka@clin.medic.mie-u.ac.jp
Yamakado
Koichiro
K
Maeda
Masayuki
M
Yasuda
Masayo
M
Akeboshi
Masao
M
Takaki
Haruyuki
H
Hamada
Ayumi
A
Takeda
Kan
K
D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015996:Survival Rate; D016896:Treatment Outcome
D001843:Bone Cements