Thermal ablation in painful bone metastases: a systematic review

Congress:

ECR 2018

Poster Number:

C-2913

Type:

Scientific Exhibit

Keywords:

Interventional non-vascular, Bones, Musculoskeletal bone, CT, MR, Percutaneous, Ablation procedures, Comparative studies, Complications, Cancer, Biological effects, Outcomes

Authors:

N. Gennaro, E. Lanza, L. Balzarini, A. Chiti, L. M. Sconfienza; Milan/IT

DOI:

10.1594/ecr2018/C-2913

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2913

Fig. 1: Flow chart illustrating the inclusion and exclusion process.

Fig. 2: Pain scores at 0,1,3 months for every ablation technique.

Fig. 4: Complications after MWA. Minor and major complications have been considered.

Fig. 5: Complications after CA. Minor and major complications have been considered.

Aims and objectives

This is a systematic review of minimally invasive thermal ablative techniques aimedto provide pain relief to patients with bone metastases. We reviewed efficacy, duration of pain relief and complications of themajor ablation techniques: radiofrequency (RFA), microwave (MWA), cryoablation (CA) and MR-guided focused ultrasound (MRgFUS). The primary endpoint was to determine the variation of referred pain after treatment at different time points; the secondary endpoint was toassess procedural complication rates for each technique.

Methods and materials

We searched MEDLINE/Pubmed, MEDLINE In-Process, EMBASE, the Cochrane database using the keywords “ablation”, “painful”, “bone”, “metastases” combined in multiple algorithms. Inclusion criteria were: 1) original clinical studies published between 2001 and 2016 2) RFA, MWA, CA or MRgFUS 3) quantitative pain assessment before and after thermal ablation of bone metastasis. Exclusion criteria were: a) patient population n<5 b) lack of pain assessment at 1 and 3 months after the procedure. Pain scales used were converted to a ten-point scale to be compared. Out of a...

Results

100% of technical success with effective pain reduction up to 6-month follow-up was reported. Pre-procedural mean pain score was 7.03±1.08. At 1 month patients experienced a mean pain relief of 3.71±0.77 points after RFA, 5.33±0.25 after MWA, 3.68±1.34 after CA and 3.94±0.92 after MRgFUS. At 3 months pain relief further increased (4.40±1.24 for RFA, 5.18±0.04 for MWA, 4.4±0.92 for MRgFUS, 4.98±0.61 for CA). MRgFUS treatments caused no complications (0%) whereas MWA was associated with the highest complication rate (30%). Pain relief curves are shown in...

Conclusion

All techniques offered significant pain relief after 1 and 3 months confirming the role of thermal ablation in palliation of bone metastases. At 3 months observed painreduction rates were: RFA = 44%, MWA = 52%, MRgFUS = 44%. CA = 50% . MRgFUS has shown negligible complications rate, whereas MWA had a noteworthy rate of adverse events. A standardized pain reporting should be adopted in future studies for meta-analysis.

Personal information

References

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