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

Skeletal Radiol. 2019 Aug;48(8):1161-1169. doi: 10.1007/s00256-018-3140-0. Epub 2019 Jan 9.

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.

Keywords: Ablation; Bone; Cryoablation; Focused ultrasound; Metastasis; Microwave; Pain; Radiofrequency.

Publication types

  • Review

MeSH terms

  • Ablation Techniques*
  • Bone Neoplasms / complications*
  • Bone Neoplasms / secondary*
  • Cancer Pain / etiology
  • Cancer Pain / therapy*
  • Humans
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / therapy*