Percutaneous image-guided radiofrequency ablation of painful bone metastases

ABSTRACT

To determine the value of radiofrequency ablation [RFA] in alleviating pain in patients with refractory pain secondary to bone metastases. Over 11 months, [from January 2006 to November 2006] 14 patients with painful osteolytic metastases were treated with image-guided radiofrequency ablation. The inclusion criteria were pain score >/= 4 [scale of 0-10] over a 24-hour period not responding to standard treatment such as radiation or opioid analgesics, or patients unfit for radiotherapy. Primary pain assessment and follow- were according to the Brief Pain Inventory-Short Form, Worst pain intensity was the primary end point with a 2-units drop considered clinically significant. Follow-up was scheduled one day post procedure, then weekly for one month and thereafter every other week, up to six months. Analgesics used were also recorded at these follow-up intervals. Follow-up contrast enhanced CT was performed one week after the procedure. Complications were monitored. The procedure was technically successful in all patients. Initial pain relief was achieved in 100% of patients [14 of 14]. There was a significant decrease in the VAS [visual analogue scale] score from 7 +/- 2.4 to 1.2 +/- 1.8 Analgesic reduction was achieved in 92.9% [13 out of 14 patients]. The tumor necrosis ratio ranged from 40% to 100% [mean, 67.1% +/- 5.9]. No serious complications were observed. There was transient local pain in most cases. Adverse events were seen in 2 patients, including a second degree skin burn at the grounding pad site in one patient and transient bowel and bladder incontinence following treatment of metastases involving the sacrum in the second patients. RFA is effective and safe for palliation of pain in cases of osteolytic metastases. It provides significant pain relief for patients who have failed standard treatment