Thermal ablation to relieve pain from metastatic bone disease: a systematic review

Nicolò Gennaro, Luca Maria Sconfienza, Federico Ambrogi, Sara Boveri, Ezio Lanza

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To review the efficacy of percutaneous thermal ablation (TA) of bone metastases (radiofrequency ablation [RFA], microwave ablation [MWA], cryoablation [CA], and MR-guided focused ultrasound [MRgFUS]) in reducing pain in patients with advanced stage cancer. Materials and Methods: We searched MEDLINE/PubMed, MEDLINE In-Process, BIDS ISI, Embase, CINAHL, and the Cochrane database using the keywords “ablation,” “painful,” “bone,” and “metastases” combined in multiple algorithms. Inclusion criteria were: original clinical studies published between 2001 and 2018; performance of RFA, MWA, CA or MRgFUS; and quantitative pain assessment before/after TA of bone metastasis. Results: Eleven papers (3 on RFA, 1 on MWA, 2 on CA, and 5 on MRgFUS) involving 364 patients were reviewed. A technical success rate of 96–100% was reported, with follow-up for up to 6 months. At baseline, pain scores ranged from 5.4 to 8, at 1–4 weeks from 0.5 to 5, and at 12 weeks from 0.3 to 4.5. Mean pain reduction compared with baseline ranged from 26 to 91% at 4 weeks and from 16% to 95% at 12 weeks. MWA treatments caused no complications, whereas MRgFUS showed the highest complication rate. The number of minor complications observed ranged from 0 to 59 (complication ratio 0–1.17), whereas the number of significant adverse effects ranged from 0 to 4 (complication ratio 0–0.04). Conclusion: All techniques achieved pain relief after 1 and 3 months, in up to 91% and 95% of patients respectively. MWA showed a negligible complication rate, whereas MRgFUS is associated with a noteworthy rate of adverse events. Future studies should adopt a standardized pain reporting scale to allow for meta-analysis.

Original languageEnglish
Pages (from-to)1161-1169
Number of pages9
JournalSkeletal Radiology
Volume48
Issue number8
DOIs
Publication statusPublished - Aug 2019

Keywords

  • Ablation
  • Bone
  • Cryoablation
  • Focused ultrasound
  • Metastasis
  • Microwave
  • Pain
  • Radiofrequency

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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