Safety and Feasibility of Steerable Radiofrequency Ablation in Combination with Cementoplasty for the Treatment of Large Extraspinal Bone Metastases

Claudio Pusceddu, Davide De Francesco, Nicola Ballicu, Domiziana Santucci, Salvatore Marsico, Massimo Venturini, Davide Fior, Lorenzo Paolo Moramarco, Eliodoro Faiella, Claudio Pusceddu, Davide De Francesco, Nicola Ballicu, Domiziana Santucci, Salvatore Marsico, Massimo Venturini, Davide Fior, Lorenzo Paolo Moramarco, Eliodoro Faiella

Abstract

Background: Radiofrequency ablation (RFA) and cementoplasty, individually and in concert, has been adopted as palliative interventional strategies to reduce pain caused by bone metastases and prevent skeletal related events. We aim to evaluate the feasibility and safety of a steerable RFA device with an articulating bipolar extensible electrode for the treatment of extraspinal bone metastases. Methods: All data were retrospectively reviewed. All the ablation procedures were performed using a steerable RFA device (STAR, Merit Medical Systems, Inc., South Jordan, UT, USA). The pain was assessed with a VAS score before treatment and at 1-week and 3-, 6-, and 12-month follow-up. The Functional Mobility Scale (FMS) was recorded preoperatively and 1 month after the treatment through a four-point scale (4, bedridden; 3, use of wheelchair; 2, limited painful ambulation; 1, normal ambulation). Technical success was defined as successful intraoperative ablation and cementoplasty without major complications. Results: A statistically significant reduction of the median VAS score before treatment and 1 week after RFA and cementoplasty was observed (p < 0.001). A total of 6/7 patients who used a wheelchair reported normal ambulation 1 month after treatment. All patients with limited painful ambulation reported normal ambulation after the RFA and cementoplasty (p = 0.003). Technical success was achieved in all the combined procedures. Two cement leakages were reported. No local recurrences were observed after 1 year. Conclusions: The combined treatment of RFA with a steerable device and cementoplasty is a safe, feasible, and promising clinical option for the management of painful bone metastases, challenging for morphology and location, resulting in an improvement of the quality of life of patients.

Keywords: bone metastases; cementoplasty; radiofrequency ablation (RFA); steerable device.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Median VAS score follow-up evaluated before and prospectively after 1 week, and 1, 3, 6 and 12 months from the treatment. The red line indicates patients’ changes in pain.
Figure 2
Figure 2
Successful treatment with tRFA and osteoplasty of painful breast cancer metastases of the right femur in a 61-year-old woman. Axial CT and Coronal-CT reconstruction showed a 52 mm lesion located in the head and neck of the right femur (A,C). Coronal-CT reconstruction showed the placements of the steerable bipolar radiofrequency device (tSTAR) (arrow). A second cannula is placed through the greater trochanter to extend osteoplasty (arrowhead) (B). Axial and Coronal-CT reconstruction showed the result after osteoplasty with PMMA (D,E).
Figure 3
Figure 3
Treatment with tRFA and osteoplasty of a sacral metastasis from breast cancer in a 62-year-old woman. Axial CT scan showed a 37 mm lytic metastasis of the left sacral ala (A). The metastasis was reached with a 10-gauge Stabilit cannula (B). Axial CT showed two different placements of the steerable radiofrequency bipolar device (tSTAR) covering the entire lesion (arrows) (C,D). Axial CT scan showed the metastasis filled by PMMA (E).
Figure 4
Figure 4
Treatment with tRFA and osteoplasty of an osteolytic metastasis of the posterior column of the right hip from breast cancer in a 65-year-old woman (A). Axial CT showed the placement of the steerable radiofrequency bipolar device (tSTAR) (B). Axial CT scan showed the metastases filled by PMMA (C). Axial CT after 12 months showed a partial recalcification of the posterior column of the hip and disappearance of the tumor mass (D).

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