Prospective pilot-study of combined bipolar radiofrequency ablation and application of bone cement in bone metastases.

BACKGROUND: The purpose of this study was to determine the efficacy and safety of radiofrequency ablation (RFA) of bone metastases of breast cancer and to compare RFA alone and RFA with additional bone cement application. The primary objectives were to compare pain reduction and quality of life during long-term follow-up in a prospective pilot study. PATIENTS AND METHODS: Sixteen female patients with painful spinal bone metastases of human breast cancer were included in this prospective pilot study (mean age 59.5 years, range 52 - 69 years). RFA was performed with computed tomographic guidance and under local anesthesia. A bipolar and impedance-controlled radiofrequency system was used. Following RFA, bone cement was injected into the necrosis cavity in half of the patients (n=8). Pain, quality of life and complications were evaluated. Mean follow-up time was 20.4 months (range 8-36). Paired comparison procedures were used for analysis of the results. A review of the literature was carried out. RESULTS: In both groups (RFA alone and RFA with additional bone cement application), pain was reduced significantly (mean reduction of pain 51.7%, p=0.0065). Quality of life was improved up to 61%. All procedures were performed without side-effects and complications. Imaging showed a complete ablation of the bone tumor in all patients. No local tumor progression was seen. CONCLUSION: RFA is a safe and effective option in the palliative therapy of bone tumors. Application of bone cement into the necrosis cavity has no significant additional effect on the reduction of pain and the improvement in quality of life. In selected cases with big bone defects, combining RFA and bone cement application is a useful option to stabilize the bone.

Autoimmune pancreatitis in an 11-year-old boy.

We report a case of histopathologically proven autoimmune pancreatitis in an 11-year-old boy. Abdominal US and MRI showed a focal swelling of the pancreatic head, the latter also showing delayed contrast enhancement. There was diffuse irregular pancreatic duct narrowing, compression of the intrapancreatic common bile duct, and mild proximal biliary dilatation on MR cholangiopancreatography. Laboratory results revealed normal serum IgG and subclass 4 with negative autoimmune antibodies, and slightly elevated carbohydrate antigen 19-9. This highlights the differentiation of autoimmune pancreatitis from pancreatic head cancer and, to a lesser extent, other forms of pancreatitis in children.