Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma.
OBJECTIVE
The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC).


METHODS
Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); the second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose.


RESULTS
The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed.


CONCLUSIONS
RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.
Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese, Italy. gcarraf@tin.it
Gianpaolo
G
Carrafiello
Domenico
D
Laganà
Andrea
A
Ianniello
Paolo
P
Nicotera
Federico
F
Fontana
Massimiliano
M
Dizonno
Salvatore
S
Cuffari
Carlo
C
Fugazzola
D000368:Aged; D018771:Arthralgia / Q000209:etiology / Q000517:prevention & control*; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome