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Percutaneous Image-Guided Radiofrequency Ablation of Painful Metastases Involving Bone: A Multicenter Study

From the Departments of Oncology, Diagnostic Radiology, Anesthesiology, Biostatistics, and Radiation Oncology, Mayo Clinic, Rochester, MN; St Luke's Hospital, Milwaukee, WI; Institute for Cancer Research and Treatment, Torino; Department of Orthopaedic Oncology, CTO, Florence, Italy; Department of Radiology, Northwestern University Medical School, Chicago, IL; Institut for Microtherapy, Department of Radiology and Microtherapy, University Witten/Herdecke, Germany; Department of Radiology, M.D. Anderson Cancer Center, Houston, TX; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiology, Institut Gustave Roussy, Villejuif, France

Address reprint requests to J. William Charboneau, MD, Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: charboneau.william{at}mayo.edu

PURPOSE: Few options are available for pain relief in patients with bone metastases who fail standard treatments. We sought to determine the benefit of radiofrequency ablation (RFA) in providing pain relief for patients with refractory pain secondary to metastases involving bone.

PATIENTS AND METHODS: Thirty-one US and 12 European patients with painful osteolytic metastases involving bone were treated with image-guided RFA using a multitip needle. Treated patients had 4/10 pain and had either failed or were poor candidates for standard treatments such as radiation or opioid analgesics. Using the Brief Pain Inventory–Short Form, worst pain intensity was the primary end point, with a 2-unit drop considered clinically significant.

RESULTS: Forty-three patients were treated (median follow-up, 16 weeks). Before RFA, the mean score for worst pain was 7.9 (range, 4/10 to 10/10). Four, 12, and 24 weeks following treatment, worst pain decreased to 4.5 (P < .0001), 3.0 (P < .0001), and 1.4 (P = .0005), respectively. Ninety-five percent (41 of 43 patients) experienced a decrease in pain that was considered clinically significant. Opioid usage significantly decreased at weeks 8 and 12. Adverse events were seen in 3 patients and included (1) a second-degree skin burn at the grounding pad site, (2) transient bowel and bladder incontinence following treatment of a metastasis involving the sacrum, and (3) a fracture of the acetabulum following RFA of an acetabular lesion.

CONCLUSION: RFA of painful osteolytic metastases provides significant pain relief for cancer patients who have failed standard treatments.

Supported in part by RITA Medical Systems, Mountain View, CA

Presented in part at the American Society of Clinical Oncology 2002 Annual Meeting (May 18-21, 2002, Orlando, FL) and the Radiological Society of North America 2002 Annual Meeting, December 1-6, 2002, Chicago, IL.

M.P.G. and M.R.C. contributed equally to this article.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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