A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases

• Published in: European radiology 2011-09, Vol.21 (9), p.2004-2010
• Main Authors: Di Staso, M., Zugaro, L., Gravina, G. L., Bonfili, P., Marampon, F., Di Nicola, L., Conchiglia, A., Ventura, L., Franzese, P., Gallucci, M., Masciocchi, C., Tombolini, V.
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Analgesics; Bone; Bone Neoplasms - mortality; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Bone Neoplasms - surgery; Catheter Ablation - methods; Chi-Square Distribution; Clinical trials; Cohort Studies; Combined Modality Therapy; Confidence Intervals; Diagnostic Radiology; Drug dosages; Feasibility Studies; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Metastases; Metastasis; Morbidity; Morphine; Narcotics; Neuroradiology; Oncology; Osteolysis; Osteolysis - radiotherapy; Osteolysis - surgery; Pain; Pain Management - methods; Pain Measurement; Pain, Intractable - radiotherapy; Pain, Intractable - surgery; Palliation; Palliative Care; Prognosis; Radiation therapy; Radiology; Radiotherapy; Radiotherapy - methods; Response rates; Risk Assessment; Spinal cord; Statistics; Statistics, Nonparametric; Survival Analysis; Tumors; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-011-2133-3

Objectives To determine whether Radiofrequency Ablation (RFA) followed by Radiotherapy (RT) (RFA-RT) produces better palliation in terms of pain than RT alone in patients with osteolytic bone metastases. Methods Patients with solitary bone metastases and a pain score of least 5 or more on the VAS scale were selected. Fifteen patients were treated with RFA-RT (20 Gy delivered in 5 fractions of 4 Gy over 1 week) and were compared with a matched group (30 subjects) treated by RT. Results A complete response in terms of pain relief at 12 weeks was documented in 16.6% (5/30) and 53.3% (8/15) of the subjects treated by RT or RFA-RT, respectively ( p  = 0.027). The overall response rate at 12 weeks was 93.3% (14 patients) in the group treated by RFA-RT and 59.9% (18 patients) in the group treated by RT ( p  = 0.048). Although recurrent pain was documented more frequently after RT (26.6%) than after RFA-RT (6.7%) the difference did not reach statistical significance. The morbidity related to RT did not significantly differ when this treatment was associated with RFA. Conclusions Our results suggest that RFA-RT is safe and more effective than RT. The findings described here should serve as a framework around which to design future clinical trials.