title: Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience.
abstract: OBJECTIVE
  The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease.
  
  
  METHODS
  This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome-including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points.
  
  
  RESULTS
  Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11%) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure.
  
  
  CONCLUSIONS
  CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease.
authors: Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA, 30322, USA, jdprologo@hotmail.com.
authors: J David
authors: JD
authors: Prologo
authors: Matthew
authors: M
authors: Passalacqua
authors: Indravadan
authors: I
authors: Patel
authors: Nathan
authors: N
authors: Bohnert
authors: David J
authors: DJ
authors: Corn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis / Q000517:prevention & control*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome