Image-guided ablation of skeletal metastases
- Anil Nicholas Kurup, MD
Anil Nicholas Kurup, MD
- Associate Professor of Radiology
- Mayo Clinic College of Medicine
- Matthew R Callstrom, MD, PhD
Matthew R Callstrom, MD, PhD
- Professor of Radiology
- Mayo Clinic
- Section Editors
- Reed E Drews, MD
Reed E Drews, MD
- Section Editor — Complications of Cancer
- Associate Professor of Medicine
- Harvard Medical School
- Janet Abrahm, MD
Janet Abrahm, MD
- Section Editor — Pain: Assessment and Management
- Professor of Medicine
- Harvard Medical School
Skeletal metastases are a common manifestation of distant relapse from many types of solid cancers, especially those arising in the lung, breast, and prostate. Bone involvement can also be extensive in patients with multiple myeloma, and bone may be a primary or secondary site of disease involvement in patients with lymphoma. For the purpose of this review, all of these will be considered under the term "skeletal metastases." (See "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma" and "Primary lymphoma of bone".)
Among patients with advanced malignancy, skeletal metastases represent a prominent source of morbidity due to pain, dysfunction, pathologic fracture, and neurovascular compromise. Bone-related cancer pain is frequently undertreated, with nearly 80 percent of patients experiencing severe pain before a sufficient palliative treatment plan is initiated . (See "Evaluation and management of complete and impending pathologic fractures in patients with metastatic bone disease, multiple myeloma, and lymphoma" and "Clinical features and diagnosis of neoplastic epidural spinal cord compression, including cauda equina syndrome" and "Overview of cancer pain syndromes", section on 'Multifocal bone pain' and "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'The problem of undertreatment'.)
Treatment of skeletal metastases usually requires a multipronged approach that may include analgesics, external beam radiation therapy, surgical management, and/or vertebroplasty/kyphoplasty. A significant proportion of patients with symptomatic skeletal metastases derive no or inadequate pain relief from these measures, or they experience recurrent pain following radiation therapy and require further intervention. Given the limited life expectancy of many of these patients and the coexisting morbidity, minimally invasive methods for local ablation of skeletal metastases have been developed, including radiofrequency ablation, cryoablation, and focused ultrasound. This topic will review image-guided ablation approaches to symptomatic skeletal metastases.
OVERVIEW OF THE APPROACH TO SYMPTOMATIC SKELETAL METASTASES
The goals of management for symptomatic bone metastases include maximizing pain control, preserving and restoring function, stabilizing the skeleton, and enhancing local tumor control. (See "Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis".)
Optimal therapy typically requires a multipronged, multidisciplinary approach:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- OVERVIEW OF THE APPROACH TO SYMPTOMATIC SKELETAL METASTASES
- INDICATIONS FOR IMAGE-GUIDED ABLATION
- Patient selection
- PREPROCEDURAL IMAGING
- General aspects
- Radiofrequency ablation
- Focused ultrasound
- Other emerging percutaneous techniques
- - Bone pain
- - Local tumor control
- Choice of method
- SUMMARY AND RECOMMENDATIONS