Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial

Abstract

Background: This study sought to describe the results of a single-arm multicenter clinical trial using image-guided percutaneous cryoablation for the palliation of painful metastatic tumors involving bone.

Methods: Over a 44-month period, 61 adult patients with 1 or 2 painful bone metastases with a score of 4 or more on a scale of 0 to 10 (≥4/10) worst pain in a 24-hour period who had failed or refused conventional treatment were treated with percutaneous image-guided cryoablation. Patient pain and quality of life was measured using the Brief Pain Inventory prior to treatment, 1 and 4 days after the procedure, weekly for 4 weeks, and every 2 weeks thereafter for a total of 6 months. Patient analgesic use was also recorded at these same follow-up intervals. Complications were monitored. Analysis of the primary endpoint was undertaken via paired comparison procedures.

Results: A total of 69 treated tumors ranged in size from 1 to 11 cm. Prior to cryoablation, the mean score for worst pain in a 24-hour period was 7.1/10 with a range of 4/10 to 10/10. At 1, 4, 8, and 24 weeks after treatment, the mean score for worst pain in a 24-hour period decreased to 5.1/10 (P < .0001), 4.0/10 (P < .0001), 3.6/10 (P < .0001), and 1.4/10 (P < .0001), respectively. One of 61 (2%) patients had a major complication with osteomyelitis at the site of ablation.

Conclusions: Percutaneous cryoablation is a safe, effective, and durable method for palliation of pain due to metastatic disease involving bone.

Copyright © 2012 American Cancer Society.

Figures

FIGURE 1

A) Noncontrast CT image of the upper chest with bone windows demonstrates an osteolytic metastasis in the medial head of the right clavicle (arrows). A cryoprobe (arrow head) is placed in the metastasis. B) Noncontrast CT image of the upper chest with body windows demonstrates an ice-ball, visible as a low-attenuation area about the cryoprobe with 0 °C at the ice-ball tissue boundary, extending beyond the margin of the clavicle and the osteolytic metastasis (arrows).

FIGURE 2

Treatment of a painful metastatic paraganglioma contained in a rib. Prior to treatment, the patient had 5/10 worst pain which was reduced to 2/10 by week 4 and 0/10 by week 8. Patient reported 0/10 pain at latest follow-up of 24 weeks. A) Contrast-enhanced CT image of the upper abdomen with body windows demonstrates an enhancing osteolytic metastasis in the left 10th rib (arrow). B) Noncontrast CT image of the upper abdomen with bone windows demonstrates a cryoprobe (arrow) placed in the metastasis C) Noncontrast CT image of the upper abdomen with body windows demonstrates an ice-ball, visible as a low-attenuation area (arrow heads) extending beyond the margin of the target tumor. D) Contrast-enhanced CT image of the upper abdomen with body windows performed following the ablation procedure shows no residual enhancement of the mass contained in the left 10th rib (arrow).

FIGURE 3

Mean BPI scores over time for patients treated with percutaneous cryoablation for (A) worst pain, (B) average pain, (C) pain interference, and (D) pain relief. Error bars represent the 95% confidence intervals. N=the number of patients completing BPI at each time point.