Percutaneous Image-Guided Cryoablation of Musculoskeletal Metastases: Pain Palliation and Local Tumor Control

J Vasc Interv Radiol. 2016 Dec;27(12):1788-1796. doi: 10.1016/j.jvir.2016.07.026. Epub 2016 Oct 13.

Abstract

Purpose: To evaluate the safety and effectiveness of cryoablation of musculoskeletal metastases in terms of achieving pain palliation and local tumor control.

Materials and methods: A retrospective review was performed of 92 musculoskeletal metastases in 56 patients treated with percutaneous image-guided cryoablation. Mean age of the cohort was 53.9 y ± 15.1, and cohort included 48% (27/56) men. Median tumor volume was 13.0 cm3 (range, 0.5-577.2 cm3). Indications for treatment included pain palliation (41%; 38/92), local tumor control (15%; 14/92), or both (43%; 40/92). Concurrent cementoplasty was performed after 28% (26/92) of treatments.

Results: In 78 tumors treated for pain palliation, median pain score before treatment was 8.0. Decreased median pain scores were reported 1 day (6.0; P < .001, n = 62), 1 week (5.0; P < .001, n = 70), 1 month (5.0; P < .001, n = 63), and 3 months (4.5; P = .01, n = 28) after treatment. The median pain score at 6-month follow-up was 7.5 (P = .33, n = 11). Radiographic local tumor control rates were 90% (37/41) at 3 months, 86% (32/37) at 6 months, and 79% (26/33) at 12 months after treatment. The procedural complication rate was 4.3% (4/92). The 3 major complications included 2 cases of hemothorax and 1 transient foot drop.

Conclusions: Cryoablation is an effective treatment for palliating painful musculoskeletal metastases and achieving local tumor control.

MeSH terms

  • Adult
  • Aged
  • Bone Neoplasms / complications
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary*
  • Bone Neoplasms / surgery*
  • Cementoplasty
  • Cryosurgery / adverse effects
  • Cryosurgery / methods*
  • Female
  • Gait Disorders, Neurologic / etiology
  • Hemothorax / etiology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Missouri
  • Muscle Neoplasms / complications
  • Muscle Neoplasms / diagnostic imaging
  • Muscle Neoplasms / secondary*
  • Muscle Neoplasms / surgery*
  • Musculoskeletal Pain / diagnosis
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / prevention & control*
  • Pain Measurement
  • Palliative Care / methods*
  • Positron Emission Tomography Computed Tomography
  • Retrospective Studies
  • Treatment Outcome
  • Tumor Burden