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:
●Analgesics, glucocorticoids, osteoclast inhibitors (bisphosphonates, denosumab), and bone-targeted radioisotopes can all provide pain relief, and osteoclast inhibitors are useful to decrease the frequency of skeletal-related events in patients with bone metastases. (See "Cancer pain management with opioids: Optimizing analgesia" and "Cancer pain management: Adjuvant analgesics (coanalgesics)", section on 'Adjuvant drugs used for bone pain' and "Osteoclast inhibitors for patients with bone metastases from breast, prostate, and other solid tumors" and "Bone metastases in advanced prostate cancer: Management", section on 'Bone-targeted radiopharmaceuticals'.)
●External beam radiation therapy (RT) with or without systemic therapy is the standard of care for alleviation of pain caused by skeletal metastases. Reduction in pain is achieved in 50 to 80 percent, and it is complete in up to one-third of patients . Newer radiation techniques, in particular stereotactic body radiotherapy, have been utilized in patients with limited metastatic disease to deliver higher radiation doses in a single or few sessions. (See "Radiation therapy for the management of painful bone metastases", section on 'External beam RT' and "Radiation therapy techniques in cancer treatment", section on 'Stereotactic radiation therapy techniques'.)
- Janjan N. Bone metastases: approaches to management. Semin Oncol 2001; 28:28.
- Chow E, Harris K, Fan G, et al. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25:1423.
- McBride JF, Atwell TD, Charboneau WJ, et al. Minimally invasive treatment of metastatic pheochromocytoma and paraganglioma: efficacy and safety of radiofrequency ablation and cryoablation therapy. J Vasc Interv Radiol 2011; 22:1263.
- Castañeda Rodriguez WR, Callstrom MR. Effective pain palliation and prevention of fracture for axial-loading skeletal metastases using combined cryoablation and cementoplasty. Tech Vasc Interv Radiol 2011; 14:160.
- McMenomy BP, Kurup AN, Johnson GB, et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol 2013; 24:207.
- Kurup AN, Morris JM, Schmit GD, et al. Neuroanatomic considerations in percutaneous tumor ablation. Radiographics 2013; 33:1195.
- Farrell MA, Charboneau JW, Callstrom MR, et al. Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol 2003; 181:1315.
- Kam AW, Littrup PJ, Walther MM, et al. Thermal protection during percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 2004; 15:753.
- Choi J, Raghavan M. Diagnostic imaging and image-guided therapy of skeletal metastases. Cancer Control 2012; 19:102.
- Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Curr Probl Diagn Radiol 2009; 38:135.
- Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality--clinical implications. Technol Cancer Res Treat 2007; 6:37.
- Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005; 33:223.
- Nanoknife system http://www.angiodynamics.com/products/nanoknife.
- Callstrom MR, Charboneau JW, Goetz MP, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol 2006; 35:1.
- Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 2004; 22:300.
- Dupuy DE, Liu D, Hartfeil D, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer 2010; 116:989.
- Callstrom MR, Dupuy DE, Solomon SB, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 2013; 119:1033.
- Tomasian A, Wallace A, Northrup B, et al. Spine Cryoablation: Pain Palliation and Local Tumor Control for Vertebral Metastases. AJNR Am J Neuroradiol 2016; 37:189.
- Hurwitz MD, Ghanouni P, Kanaev SV, et al. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. J Natl Cancer Inst 2014; 106.
- Catane R, Beck A, Inbar Y, et al. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases--preliminary clinical experience. Ann Oncol 2007; 18:163.
- Liberman B, Gianfelice D, Inbar Y, et al. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol 2009; 16:140.
- Gianfelice D, Gupta C, Kucharczyk W, et al. Palliative treatment of painful bone metastases with MR imaging--guided focused ultrasound. Radiology 2008; 249:355.
- Napoli A, Anzidei M, Marincola BC, et al. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Invest Radiol 2013; 48:351.
- http://www.accessdata.fda.gov/cdrh_docs/pdf11/P110039b.pdf (Accessed on November 30, 2012).
- Ahrar K, Stafford RJ. Magnetic resonance imaging-guided laser ablation of bone tumors. Tech Vasc Interv Radiol 2011; 14:177.
- Carrafiello G, Laganà D, Pellegrino C, et al. Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience. Radiol Med 2009; 114:608.
- Fan QY, Ma BA, Zhou Y, et al. Bone tumors of the extremities or pelvis treated by microwave-induced hyperthermia. Clin Orthop Relat Res 2003; :165.
- Grieco CA, Simon CJ, Mayo-Smith WW, et al. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses. Am J Clin Oncol 2007; 30:361.
- Groenemeyer DH, Schirp S, Gevargez A. Image-guided percutaneous thermal ablation of bone tumors. Acad Radiol 2002; 9:467.
- Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol 2013; 24:229.
- Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics 2005; 25 Suppl 1:S69.
- Kastler A, Alnassan H, Pereira PL, et al. Analgesic effects of microwave ablation of bone and soft tissue tumors under local anesthesia. Pain Med 2013; 14:1873.
- Pusceddu C, Sotgia B, Fele RM, et al. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture. Cardiovasc Intervent Radiol 2016; 39:74.
- Bang HJ, Littrup PJ, Currier BP, et al. Percutaneous cryoablation of metastatic lesions from non-small-cell lung carcinoma: initial survival, local control, and cost observations. J Vasc Interv Radiol 2012; 23:761.
- Bang HJ, Littrup PJ, Goodrich DJ, et al. Percutaneous cryoablation of metastatic renal cell carcinoma for local tumor control: feasibility, outcomes, and estimated cost-effectiveness for palliation. J Vasc Interv Radiol 2012; 23:770.
- Napoli A, Anzidei M, Marincola BC, et al. MR imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics 2013; 33:1555.
- Kurup AN, Callstrom MR. Ablation of skeletal metastases: current status. J Vasc Interv Radiol 2010; 21:S242.
- Callstrom MR, Atwell TD, Charboneau JW, et al. Painful metastases involving bone: percutaneous image-guided cryoablation--prospective trial interim analysis. Radiology 2006; 241:572.
- Thacker PG, Callstrom MR, Curry TB, et al. Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients' immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2011; 197:510.
- Callstrom MR, Kurup AN. Percutaneous ablation for bone and soft tissue metastases--why cryoablation? Skeletal Radiol 2009; 38:835.
- Masala S, Guglielmi G, Petrella MC, et al. Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series. Singapore Med J 2011; 52:182.
- Patient selection
- PRE-PROCEDURAL IMAGING
- General aspects
- Radiofrequency ablation
- Focused ultrasound
- Other emerging percutaneous techniques
- - Bone pain
- - Local tumor control
- Choice of method
- SUMMARY AND RECOMMENDATIONS