Percutaneous treatment of bone tumors by radiofrequency thermal ablation

doi:10.1016/j.ejrad.2009.06.012

European Journal of Radiology

Volume 77, Issue 1, January 2011, Pages 156-163

https://doi.org/10.1016/j.ejrad.2009.06.012 Get rights and content

Abstract

We present our experience of the treatment of bone tumors with radiofrequency thermal ablation (RFTA). Over the past 4 years, we have treated 26 cases (22 benign and 4 malignant) using CT-guided RFTA. RFTA was the sole treatment in 19 cases and was combined with percutaneous cementation during the same session in the remaining seven cases.

Our approach to the tumors was simplified, using a single point of entrance for both RFTA and percutaneous osteoplasty.

In the benign cases, clinical success was defined as resolution of pain within 1 month of the procedure and no recurrence during the follow-up period. It was achieved in 19 out of the 21 patients in which curative treatment was attempted. The two non-resolved cases were a patient with osteoid osteoma who developed a symptomatic bone infarct after a symptom-free period of 2 months and another with femoral diaphysis osteoblastoma who suffered a pathological fracture after 8 months without symptoms.

The procedure was considered clinically successful in the five cases (4 malign and 1 benign) in which palliative treatment was attempted, because there was a mean (±SD) reduction in visual analogue scale (VAS) pain score from 9.0 ± 0.4 before the procedure to <4 during the follow-up period.

Introduction

Image-guided radiofrequency thermal ablation (RFTA) is a branch of interventional oncology that uses direct application of radiofrequency-generated heat to coagulate and destroy tumor tissue [1]. It has been applied to treat benign bone tumors and tumor-like lesions as a single modality or as an adjunct to surgical therapy [2]. It has proven useful in metastatic disease as a palliative measure to relieve disabling pain [3].

Percutaneous delivery of polymethylmethacrylate has been used to relieve pain in patients with vertebral and skeletal neoplasms and prevent pathological fractures. The injection of bone cement into the lesion reduces the pain and stabilizes the bone [4], [5].

A combination of these two procedures is useful to achieve both destruction of tumor tissues and strengthening of bone architecture.

We present our experience with the percutaneous treatment of bone lesions by RFTA and/or cementoplasty under CT guidance. We discuss the indications for RFTA combined with cementoplasty and the usefulness of RTFA alone, especially for intra-articular tumors.

Section snippets

Patients and methods

Twenty-six patients (13 males) were treated with CT-guided RFTA at our center from 2003 to 2008. The history of symptoms before RFTA treatment ranged from 3 to 28 months (mean of 18 months).

General anesthesia was used in 15 cases, epidural in 6, and local nerve blockage in 4. RFTA was applied as a single modality in 19 patients and was combined with percutaneous cementation in 7 patients. Table 1 summarizes the characteristics of patients and their treatments.

A simplified approach to the tumors

Results

In the curative treatment group, the VAS score decreased from 8.0 ± 0.2 before treatment to mean values <1 during the follow-up period (Table 2).

Technical success was achieved in 20 out the 21 patients in this group. The unsuccessful case was an eosinophilic granuloma localized in the iliac wing. In this patient, the vertebroplasty needle broke on the edge of the bone during the pre-ablation withdrawal and was maintained in place while three ablation sessions were performed at different depths (

Discussion

Image-guided RFTA reduces pain, improving function and quality of life in patients with painful bone tumors. It has been used to treat benign bone tumors and tumor-like lesions as a single modality or as an adjunct to surgical therapy. RFTA also offers an alternative method for the palliation of localized painful osteolytic metastatic lesions [7].

CT-guided radiofrequency has become the standard treatment of most osteoid osteomas [2]. However, indications for RFTA treatment are expanding to

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Treatment alternatives and clinical outcomes of bone filling after benign tumour curettage. A systematic review
2022, Orthopaedics and Traumatology: Surgery and Research
Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling?
The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest.
The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96.
Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity.
III; systematic review.
Percutaneous CT-guided radiofrequency ablation of osteoid osteoma: Potential Pitfalls and complications and how to avoid them: CT-guided Radiofrequency Ablation of Osteoid Osteoma
2022, Journal of Clinical Orthopaedics and Trauma
Targeted cannulation of the nidus and subsequent thermal ablation is the basis of CT-guided radiofrequency ablation (RFA) of osteoid osteoma, which is considered nowadays as the treatment of choice. The majority of complications during this procedure are due to thermal injury of adjacent structures. Specific measures as per the anatomical location of osteoid osteoma can avoid the majority of complications. This article enlists the possible complications and their necessary precautions and remedies to avoid these complications during CT-guided radiofrequency ablation of osteoid osteoma.
Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation
2021, European Journal of Radiology
Citation Excerpt :
Articular cartilage can also be harmed in the procedure, causing premature osteoarthritis. The risk of these long-term complications probably increases with young age of the patient and the size and proximity of the lesion to the growth plate and articular cartilage [4–7]. Radiofrequency thermal ablation (RFA) has been advocated as an alternative curative therapy in chondroblastoma because it is considered a less aggressive approach than surgery [4,5].
To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma.
This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm).
According to tumour size and location, monopolar electrode’s active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases.
Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale.
Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse.
In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed.
Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.
Effectiveness of Radiofrequency Ablation in the Treatment of Painful Osseous Metastases: A Correlation Meta-Analysis with Machine Learning Cluster Identification
2020, Journal of Vascular and Interventional Radiology
A systematic review and meta-analysis of pain response after radiofrequency (RF) ablation over time for osseous metastases was conducted in 2019. Analysis used a random-effects model with GOSH plots and meta-regression. Fourteen studies comprising 426 patients, most with recalcitrant pain, were identified. Median pain reduction after RF ablation was 67% over median follow-up of 24 weeks (R² = −.66, 95% confidence interval −0.76 to −0.55, I² = 71.24%, fail-safe N = 875) with 44% pain reduction within 1 week. A low-heterogeneity subgroup was identified with median pain reduction after RF ablation of 70% over 12 weeks (R² = −.75, 95% confidence interval −0.80 to −0.70, I² = 2.66%, fail-safe N = 910). Addition of cementoplasty after RF ablation did not significantly affect pain scores. Primary tumor type and tumor size did not significantly affect pain scores. A particular, positive association between pain after RF ablation and axial tumors was identified, implying possible increased palliative effects for RF ablation on axial over appendicular lesions. RF ablation is a useful palliative therapy for osseous metastases, particularly in patients with recalcitrant pain.
CT-guided radiofrequency ablation in patients with aneurysmal bone cysts
2018, European Journal of Radiology
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No recurrence during the whole period of follow-up, combination of RFTA with cementoplasty was indicated in lesions in weight-bearing areas to give more support also to avoid pathological fractures, this combined treatment strategy also has been reported to be useful in achieving coagulative necrosis and stabilization of the treated lesions [19]. Coagulation necrosis resulted from RFTA also enhances a homogenous distribution of the cement material within the treated lesions [21]. Selective arterial embolization can be considered not only as a preoperative adjunct treatment to decrease intraoperative blood loss but also as a primary treatment modality [12], but one of the main disadvantages of this procedure is the relatively high recurrence or even persistence rate of the lesion in patients who have been followed up for 2 years or more at this rate was about 39%, as described by Rossi et al. [12].
Aneurysmal bone cyst (ABC) is one of most therapeutic challenging lesions for orthopedic surgeons specially in large-sized lesions and lesions, which are very close to important neurovascular structures. In the present study, we express our experience in the treatment of aneurysmal bone cyst by radiofrequency thermal ablation (RFTA).
In the last two years, we have treated 20 cases (12 males & 8 females) presented with painful aneurysmal bone cysts in different anatomical locations, the age mean (±SD) is 18.95 ± 8.02 years and median is 17.5 years, the mean size of the lesions (±SD) is: 32.25 ± 7.15 mm & the median (range) is 33.5 mm (18.0–43.0) mm. The treatment was done by (RFTA) only in 11 cases and by (RFTA) with cementation in the other 9 cases, then the patients underwent close clinical follow-up for clinical symptoms by using visual analogue scale (VAS) pain score & radiological follow-up for one month, six months & one year after the procedure.
Close follow-up for the patients proved that (RFTA) is a clinically successful &curative treatment as there was significant reduction in the mean (±SD) of the (VAS) pain score in all treated cases from 8.40 ± 1.23 before the intervention to 0.20 ± 0.41 at the end of follow-up period. No recorded post-procedural complications or recurrence during or at the end of the follow-up period.
Removal of osteoblastoma of the talar neck using standard anterior ankle Arthroscopy:A case report
2016, International Journal of Surgery Case Reports
Osteoblastoma of the talus, a benign tumor, is rare in orthopedics. The choice of treatment is usually open surgery for excision of tumor. Limited data is available concerning arthroscopic approaches.
A 36-year-old male patient was evaluated for pain and swelling of the left ankle joint. Based on the findings of physical examination, X-rays and MRI investigations, the tumor was isolated. Standard anterior arthroscopic surgery was performed due to ankle pain. A diagnosis of osteoblastoma of the talar neck was made following the pathological survey. He had no recurrent pain and normal joint mobility 5 years postoperatively during he was regularly followed up.
Osteoblastoma of the talar neck is slowly progressive and it is a palpable painful mass. Open or arthroscopic surgery can be performed. Treatment strategies are decided on according to the tumor's location, extent and size. Some advantages of arthroscopic surgery are wide visualization areas, minimally invasion, low morbidity, no necessity for casting and immobilization, early rehabilitation and quick recovery.
In conclusion, arthroscopic management can be successful in selected patients with small benign tumor localized to the ankle joint.

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Percutaneous treatment of bone tumors by radiofrequency thermal ablation

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

J Vasc Interv Radiol

J Vasc Interv Radiol

Orthop Clin North Am

J Vasc Interv Radiol

J Vasc Interv Radiol

Image-guided tumor ablation: standardization of terminology and reporting criteria

Radiology

Osteoid osteoma: percutaneous treatment with radiofrequency energy

Radiology

Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation

Radiology

Percutaneous vertebroplasty

Radiology

Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

Skeletal Radiol

Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results

Eur Radiol

Intracortical chondroma simulating osteoid osteoma treated by radiofrequency

Skeletal Radiol

Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure

Radiology