title: Percutaneous Image-Guided Cryoablation of Musculoskeletal Metastases: Pain Palliation and Local Tumor Control.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of cryoablation of musculoskeletal metastases in terms of achieving pain palliation and local tumor control.
  
  
  METHODS
  A retrospective review was performed of 92 musculoskeletal metastases in 56 patients treated with percutaneous image-guided cryoablation. Mean age of the cohort was 53.9 y ± 15.1, and cohort included 48% (27/56) men. Median tumor volume was 13.0 cm3(range, 0.5-577.2 cm3). Indications for treatment included pain palliation (41%; 38/92), local tumor control (15%; 14/92), or both (43%; 40/92). Concurrent cementoplasty was performed after 28% (26/92) of treatments.
  
  
  RESULTS
  In 78 tumors treated for pain palliation, median pain score before treatment was 8.0. Decreased median pain scores were reported 1 day (6.0; P < .001, n = 62), 1 week (5.0; P < .001, n = 70), 1 month (5.0; P < .001, n = 63), and 3 months (4.5; P = .01, n = 28) after treatment. The median pain score at 6-month follow-up was 7.5 (P = .33, n = 11). Radiographic local tumor control rates were 90% (37/41) at 3 months, 86% (32/37) at 6 months, and 79% (26/33) at 12 months after treatment. The procedural complication rate was 4.3% (4/92). The 3 major complications included 2 cases of hemothorax and 1 transient foot drop.
  
  
  CONCLUSIONS
  Cryoablation is an effective treatment for palliating painful musculoskeletal metastases and achieving local tumor control.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110. Electronic address: wallacea@mir.wustl.edu.
authors.forename: Adam N
authors.initials: AN
authors.lastname: Wallace
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Sebastian R
authors.initials: SR
authors.lastname: McWilliams
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Connolly
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: John S
authors.initials: JS
authors.lastname: Symanski
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Devin
authors.initials: D
authors.lastname: Vaswani
authors.affiliation: Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Anderanik
authors.initials: A
authors.lastname: Tomasian
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ross
authors.initials: R
authors.lastname: Vyhmeister
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lee
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Madaelil
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Hillen
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Jennings
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D060826:Cementoplasty; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008923:Missouri; D019042:Muscle Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden