Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease.
OBJECTIVE
To evaluate the feasibility and effectiveness of combining radiofrequency (RF) ablation and osteoplasty for pain reduction in the treatment of painful osteolytic metastases.


METHODS
Within 5 years, 22 patients (15 men and seven women; median age, 64 years) with 28 lesions located in the thoracic and lumbar spine, sacrum, pelvis, acetabulum, femur, and tibia were treated. Underlying tumors were breast, lung, renal cell, thyroid, cancer of unknown primary, and multiple myeloma. RF ablation was performed with the patient under moderate sedation and computed tomographic fluoroscopy guidance and was immediately followed by cement injection. Pain relief was evaluated with the visual analogue scale (VAS) score and the extent to which analgesics could be reduced. Clinical success was defined as a substantial reduction in pain and/or a reduced demand for analgesics, and technical success was defined as distribution of cement between both endplates of a vertebral body or at least 75% filling of osteolyses in other bones.


RESULTS
Technical success and pain relief was achieved in all patients. Pain ratings with the VAS decreased from a mean of 8.5 to a mean of 5.5 after 24 hours (P < .01), and a further decrease was detected after 3 months to 3.5 (P < .01). The amount or strength of analgesics was reduced in 15 patients and remained unchanged in five. In two patients, the amount of analgesics increased due to tumor progression elsewhere. No major complication, no clinically obvious fracture of a formerly treated bone or treatment-related death, occurred.


CONCLUSIONS
RF ablation and osteoplasty can be combined within one session and is both feasible and useful for the treatment of osteolytic bone metastases with regard to pain relief.
Hoffmann
Ralf Thorsten
RT
Institute of Clinical Radiology, Ludwig-Maximilians-University-Campus Grosshadern, Munich, Germany. rthoffma@med.uni-muenchen.de
Jakobs
Tobias F
TF
Trumm
Christoph
C
Weber
Christof
C
Helmberger
Thomas K
TK
Reiser
Maximilian F
MF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy*; D017115:Catheter Ablation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000628:therapy; D010146:Pain; D010147:Pain Measurement; D010166:Palliative Care; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty
D000700:Analgesics; D001843:Bone Cements; D019904:Polymethyl Methacrylate