Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial

Damian E Dupuy, Dawei Liu, Donna Hartfeil, Lucy Hanna, Jeffrey D Blume, Kamran Ahrar, Robert Lopez, Howard Safran, Thomas DiPetrillo, Damian E Dupuy, Dawei Liu, Donna Hartfeil, Lucy Hanna, Jeffrey D Blume, Kamran Ahrar, Robert Lopez, Howard Safran, Thomas DiPetrillo

Abstract

Background: The study was conducted to determine whether radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease.

Methods: The single-arm prospective trial included patients with a single painful bone metastasis with unremitting pain with a score >50 on a pain scale of 0-100. Percutaneous computed tomography-guided RFA of the bone metastasis to temperatures >60 degrees C was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, 1 month, and 3 months after RFA.

Results: Fifty-five patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%) patients. RFA reduced pain at 1 and 3 months for all pain assessment measures. The average increase in pain relief from pre-RFA to 1-month follow-up is 26.3 (95% confidence interval [CI], 17.7-34.9; P < .0001), and the increase from pre-RFA to 3-month follow-up is 16.38 (95% CI, 3.4-29.4; P = .02). The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9 (P < .0001) and 14.2 for 3-month follow-up (P = .02). The odds of lower pain severity at 1-month follow-up were 14.0 (95% CI, 2.3-25.7; P < .0001) times higher than at pre-RFA, and the odds at 3-month follow-up were 8.0 (95% CI, 0.9-15.2; P < .001) times higher than at pre-RFA. The average increase in mood from pre-RFA to 1-month follow-up was 19.9 (P < .0001) and 14.9 to 3-month follow-up (P = .005).

Conclusions: This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases.

Figures

Figure 1
Figure 1
Summary box plots of the changes in pain score (a), pain relief (b), mood (c) and pain description (d).
Figure 1
Figure 1
Summary box plots of the changes in pain score (a), pain relief (b), mood (c) and pain description (d).
Figure 1
Figure 1
Summary box plots of the changes in pain score (a), pain relief (b), mood (c) and pain description (d).
Figure 1
Figure 1
Summary box plots of the changes in pain score (a), pain relief (b), mood (c) and pain description (d).
Figure 2
Figure 2
62-year old woman with T4 NSCLC status post prior radiation and chemotherapy. The patient had persistent unremitting pain. Supine CT image (a) shows the large lung mass involving the T4 vertebral body (arrow). RFA of bone-tumor interface was performed under CT-guided fluoroscopy (b,). The patient tolerated the procedure well and her pain improved dramatically. Follow-up CT images 2 years later in soft tissue (c) and bone windows (d) show mass necrosis (arrow) and partial remineralization of the bone destruction (arrow). The patient remains pain free over 2 years after RFA.
Figure 2
Figure 2
62-year old woman with T4 NSCLC status post prior radiation and chemotherapy. The patient had persistent unremitting pain. Supine CT image (a) shows the large lung mass involving the T4 vertebral body (arrow). RFA of bone-tumor interface was performed under CT-guided fluoroscopy (b,). The patient tolerated the procedure well and her pain improved dramatically. Follow-up CT images 2 years later in soft tissue (c) and bone windows (d) show mass necrosis (arrow) and partial remineralization of the bone destruction (arrow). The patient remains pain free over 2 years after RFA.
Figure 2
Figure 2
62-year old woman with T4 NSCLC status post prior radiation and chemotherapy. The patient had persistent unremitting pain. Supine CT image (a) shows the large lung mass involving the T4 vertebral body (arrow). RFA of bone-tumor interface was performed under CT-guided fluoroscopy (b,). The patient tolerated the procedure well and her pain improved dramatically. Follow-up CT images 2 years later in soft tissue (c) and bone windows (d) show mass necrosis (arrow) and partial remineralization of the bone destruction (arrow). The patient remains pain free over 2 years after RFA.
Figure 2
Figure 2
62-year old woman with T4 NSCLC status post prior radiation and chemotherapy. The patient had persistent unremitting pain. Supine CT image (a) shows the large lung mass involving the T4 vertebral body (arrow). RFA of bone-tumor interface was performed under CT-guided fluoroscopy (b,). The patient tolerated the procedure well and her pain improved dramatically. Follow-up CT images 2 years later in soft tissue (c) and bone windows (d) show mass necrosis (arrow) and partial remineralization of the bone destruction (arrow). The patient remains pain free over 2 years after RFA.

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