Abstract
Benign tumors and metastatic bone lesions can be treated by ablation techniques performed either alone or in combination with other percutaneous techniques. Ablation techniques include ethanol or acetic acid injection and thermal ablation by means of energy deposition [including laser, radiofrequency, microwave, cryoablation, radiofrequency ionization and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU)]. Goal definition of the therapy is crucial: ablation techniques can be proposed as curative treatments in benign bone tumors or oligometastatic disease (<3 lesions). Alternatively, these techniques can be proposed as palliative treatments aiming at reduction of pain, local control of the disease and tumor decompression. Depending on the lesion’s location ablation can be combined with cementation with or without further metallic augmentation; local tumor control can be enhanced by combining ablation with transarterial bland embolization or chemoembolization. Thermal ablation of bone and soft tissues is characterized by high success and relatively low rates of potential complications, mainly iatrogenic thermal damage of surrounding sensitive structures. Successful thermal ablation requires a sufficient ablation volume and thermal protection of the surrounding vulnerable structures. This article will describe the general principles governing ablation and the mechanism of action for each technique and in addition will review the literature about safety and effectiveness of percutaneous imaging-guided ablation for benign and malignant (primary and metastatic) lesions.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Pain is a common complaint in oncologic patients. Osseous metastasis is the most common source of pain (80 %) in cancer patients with ~25 % meeting no relief from analgesics [1, 2]. External beam radiotherapy achieves only partial pain relief in the vast majority of patients [1, 2]. In addition, osteonecrosis or neural damage might complicate radiotherapy sessions or the results on pain reduction might delay up to 4 weeks [1, 3]. Primary malignant bone tumors are not so common, with cumulative risk for developing bone cancer ranging from 0.7 to 0.9 % [4]. Benign bone tumors are by far more common than malignant forms [4].
Ablation techniques aim at generating cytotoxic temperatures (>60 and <−20 °C) (Table 1). Percutaneous ablation techniques include injection of chemical substances such as ethanol or acetic acid, delivery of energy (radiofrequency, microwave, laser) aiming at temperature increase, application of extreme cold (cryoablation) and high-intensity focused ultrasound (usually performed under magnetic resonance (MR) guidance which totally lacks any invasive character) [5–11]. Indications for imaging-guided ablation in bone tumors include curative and palliative treatments. Curative treatments aim at total necrosis of benign lesions (osteoid osteoma, osteoblastoma <3 cm in diameter, etc.) or of specific malignant tumors (slow-growing cancers with <3 lesions of <3 cm in diameter each) [5]. Palliative treatments aim at pain reduction and tumor debulking [5]. Occasionally, ablation should be combined with osteoplasty to prevent impending pathologic fractures [5–9].
This article will describe the general principles governing ablation and the mechanism of action for each technique and in addition will review the literature on safety and effectiveness of percutaneous imaging-guided ablation for benign and malignant (primary and metastatic) lesions.
General principles
Ablation of bone lesions requires some kind of anesthesia (usually sedation or general anesthesia are preferred). The presence of anesthesiologist will increase technical and clinical efficacy and at the same time decrease potential complication rates. Similar to all interventional techniques in the musculoskeletal system, ablation is performed under extended sterility measures and antibiotic prophylaxis [5, 6]. Imaging is necessary for exact positioning of the ablation device inside the lesion. Whenever there is intact cortex surrounding the target, a trocar is used for a coaxial approach. Once the ablation device is in position, the trocar should be withdrawn outside the expected ablation zone to avoid energy transmission with subsequent skin and soft tissue burns. Protective techniques for preventing iatrogenic damage to surrounding nerves and other sensitive structures should be applied whenever the ablation zone is expected to extend to a distance <1 cm. These techniques include skin protection, temperature measurement, monitoring of nerve root function and dissection of sensitive structures away from the ablation zone by means of gas (room air or CO2) or fluid [12–14]. Knowledge of where a sensitive structure is located is a prerequisite for a safe and efficacious ablation session.
Ablation techniques
Chemical ablation
During ethanol or acetic acid injection, cellular dehydration, vascular thrombosis and ischemia occur resulting in target necrosis [5]. A major disadvantage of the technique is the unpredictable diffusion of the injectate. Chemical ablation was used mainly in osteolytic lesions not only for tumor necrosis but for pain reduction as well (due to the neurolysis effect) [5]. A spinal needle (usually 22 Gauge in diameter) is inserted in the lesion and the chemical agent mixed with contrast medium (for improved visualization) is injected. Depending on the size of the lesion to be treated 3–25 ml of sterile 95 % ethanol is administrated in a single or repeated sessions [5]. The mean success rate for pain reduction is 74 % with optimum results achieved within 24 h post-injection [5].
Radiofrequency ablation
During radiofrequency ablation (RFA) a closed circuit is formed consisting of the generator, the patient, the RFA probe and the grounding pads. Radiofrequency energy is dispersed between the cathode of the circuit (RF probe) and the grounding pads. Energy released from the probe via molecular movement and agitation causes temperature increase resulting in coagulation necrosis [15]. Radiofrequency ablation is sensitive to “heat sink” effect, a term used to describe heat loss due to cooling from the flowing blood inside a nearby vessel of a diameter >3 mm [15]. Electrodes used during RFA include monopolar (single tip or multitined expandable, internally cooled, perfusion) or bipolar ones [15]. A separate group of radiofrequency ablation includes coblation (radiofrequency ionization used mainly for tumor decompression) (Fig. 1). In case of intact cortex, a trocar can be used to gain access to the lesion and then the electrode is inserted coaxially.
Microwave ablation
During microwave ablation (MWA), energy radiates from an antenna into the tissue resulting in direct heating of tissue volume surrounding the antenna. The heat in microwave ablation results from dielectric hysteresis [16, 17]. Unlike RFA, MWA is not limited by tissue conductivity and impedance; in addition, microwaves penetrate charred or desiccated tissue [16, 17]. Microwaves are not governed by “heat sink effect” and they produce a larger ablation zone in a shorter period of time (Fig. 2). For large-sized lesions, multiple antennae can be inserted to create the necessary ablation zone. Once again whenever osseous cortex is intact, a trocar is required to gain access. As in RFA, this trocar has to be removed outside the expected ablation zone prior to initiation of energy deposition.
Laser ablation
During laser ablation, a fiber transmits infrared light energy which results in cytotoxic temperature [5]. In general practice, laser fibers of wavelength near the infrared spectrum are used [neodymium–yttrium–aluminum–garnet (Nd:YAG) diode laser 800–1,000 nm] [5]. A trocar is required for the laser fiber to gain access to the lesion. Laser ablation results in a small-sized ablation zone and therefore is indicated for osteoid osteoma, small-sized lesions and in patients with a contraindication to radiofrequency ablation (metallic implants, pacemakers, etc.). To increase the diameter of the ablation zone one, multiple laser fibers can be used [5].
Cryoablation
During cryoablation extreme cold is applied to induce ischemia, protein denaturation and breakdown of cellular membrane. Energy delivery occurs by means of gas (helium and argon) expansion which is governed by the Joule–Thompson law [18]. Argon expansion occurs during cooling and helium expansion occurs during thawing [18]. During cryoablation the formed ice ball is visible under imaging guidance (thus enhancing efficacy and safety) while the technique seems to be characterized by significantly lower peri- and post-procedural pain (Fig. 3). On the other hand, the required consecutive circles of freezing and thawing are time-consuming and an increased number of probes is required for adequate ablation zone, thus increasing the cost (Fig. 4). To ensure total tumor necrosis, the visible ice ball must cover the whole lesion and in addition include a safety margin of at least 5 mm. A specific complication associated to cryoablation is the cryoshock phenomenon which seems to be related to large-sized ablation volumes [5].
MR-guided HIFU
During MR-guided HIFU, focused ultrasound energy is delivered at the target resulting in focal elevated temperatures and coagulation necrosis [11]. In addition to targeting, MR guidance also provides real-time thermal monitoring. Planning of the treatment is essential and requires combined coronal, axial and sagittal sequences to be rendered three dimensional. Furthermore, planning of the treatment calculates the required energy that has to be delivered in the lesion through the skin. Treatment initially starts with sub-therapeutic sonications and post-verification continues at full therapeutic dose.
Osteoid osteoma
Osteoid osteoma is a benign bone tumor representing 11–14 % of all bone nonmalignant tumors, the third most common biopsied benign tumor and 2–3 % of all excised primary bone tumors [19]. The tumor is more common in males (M:F 1.6–4:1) with the majority of patients aged between 10 and 20 years and the majority of lesions occurring at metaphysic or diaphysis of long bones [19–21]. Patients typically complain of pain which exaggerates at night and is characteristically relieved by salicylates and nonsteroidal anti-inflammatory drugs (NSAID). Rosenthal et al. [22, 23] in 1992 first reported computed tomography (CT)-guided RFA as a treatment technique for osteoid osteomas comparing its efficacy to surgical operation. Nowadays, the therapeutic armamentarium for osteoid osteoma includes almost all thermal ablation techniques (RFA, MWA, laser, coblation and MR-guided HIFU) [24–31]. A recent systematic review of the literature for all ablation techniques performed to treat osteoid osteoma reports a 95 % success rate for pain relief and a 5 % failure rate [32]. In addition, the same systematic review reports level III evidence for recurrence prevention with guidelines including biopsy performance prior to ablation and multiple ablation sessions in large osteoid osteomas [32]. A key element in each ablation session for osteoid osteoma is a temperature of 90 °C for a prolonged ablation time [32].
Percutaneous ablation of osteoid osteoma is performed under axial imaging guidance (CT or MR), extended local sterility measures and antibiotic prophylaxis [5, 6, 33]. A trocar is required in most of cases to gain access to the nidus of the osteoid osteoma; once the trocar is in position, the ablation device is inserted coaxially (Fig. 5). The ablation protocol is performed according to the manufacturer’s guidelines for each device (Fig. 6). Imaging-guided ablation of osteoid osteoma is a safe technique with a very low rate of potential complications, including iatrogenic damage to the surrounding nerve root or tissues due to electrode placement, heat effect and size of bone necrosis [8].
Other benign tumors
A recent state-of-the-art review on interventional oncology of musculoskeletal lesions reports that “essentially any small well defined lesion at imaging can be treated with RF ablation” [8]. Usually, benign tumors to be treated by ablation include osteoblastoma (<3 cm in diameter) and chondroblastoma [5]. Throughout the literature there are reports of ablation in tumor-induced osteomalacia caused by mesenchymal benign tumors, intraosseous spinal glomus tumor, hemangiomas, chondromyxoid fibroma, intracortical chondroma, aneurysmal bone cyst, giant cell tumor and eosinophilic granuloma [8, 34–39].
Malignant tumors
Most common cancer locations include lung, colon, breast and prostate which have metastatic lesions in 20 % of the cases at presentation, while specifically for lung, breast and prostate 85 % of patients present bone metastatic lesions at the time of death [40]. Percutaneous thermal ablation can be used as curative therapy in oligolesional disease (<3 lesions). In most cases, ablation is used as a palliative therapy aiming at pain reduction and mobility improvement, tumor reduction and decompression [5–8]. The therapeutic armamentarium for these lesions includes surgery, embolization, chemotherapy, osteoplasty, ablation, radiotherapy and palliative analgesics. Surgical options in stage IV disease raise concerns concerning future life quality while chemotherapy has little effect on pain reduction [40]. Radiotherapy provides partial pain relief in most cases, it is limited for many sites and occasionally complicated by osteonecrosis or neural damage [3, 41].
Pathophysiologic explanations for pain reduction after ablation include necrosis of the interface between tumor and the pain-sensitive periosteum, tumor decompression, decrease in nerve-stimulating cytokines released by the tumor, and inhibition of osteoclastic activity [5, 7–10, 42]. A strict definition of therapeutic goal is required in ablation of a malignant lesion. Concerning pain palliation, ablation should focus at the tumor–bone interface. Whenever local control is the goal, the ablation zone should extend beyond the tumor margins. In weight-bearing areas where stabilization is additionally required ablation should be combined with cementoplasty with or without further augmentation.
Contraindications include uncorrected coagulopathy disorders, skin infection, immunosuppression and the absence of a safe path to the lesion [46]. Ability for informed consent provision is required. Tumor board meetings for decisions on local control are desirable. Ablation of malignant lesions should be performed under extended local sterility measures and antibiotic prophylaxis. Thermal protection techniques are optional and could be applied whenever the ablation zone is expected to extend close to critical or sensitive structures (e.g., nerve root, skin, etc.). So far, all ablation techniques seem to be equally effective with high efficacy rates and minimal complications [5, 7–10, 43–49]. Several published studies on the ablation of bone and soft tissue lesions report excellent results concerning safety and efficacy [11, 40–49]. The mean success rate when pain reduction is concerned is around 75–87 % [5, 9]. Ablation is a local therapy and therefore cannot be applied in patients with numerous painful lesions who should be treated with systemic therapies; in addition, in certain cases it is difficult to define few lesions responsible for the symptoms in these patients. There is a lack of studies illustrating the clinical benefit of local control by ablation which should, however, be similar to that of surgical metastasectomy [9]. Concerning primary malignant tumors, ablation can be performed as curative treatment in selected cases of osteosarcoma or soft tissue sarcoma and can provide limb salvage either performed alone or in combination with surgery [8, 50].
Combined techniques for malignant lesions
In cases of hypervascular lesions (metastatic lesions most usually originating from thyroid, renal cell or hepatocellular carcinomas), local tumor control can be enhanced by combining ablation with transarterial chemoembolization or bland embolization [51]. Triple therapies with chemoembolization, ablation and cementation have been described as well [52].
In the spine, due to weight bearing on one hand and the resultant post-ablation osteonecrosis on the other, any ablation technique should be followed by cementation [5–7]. Polymethyl methacrylate (PMMA) has been widely tested with success in the weight-bearing forces of the spine including metastatic lesions treated with ablation and cementation [53–55]. In peripheral bones, however, due to shearing forces applied during weight bearing, PMMA alone might be insufficient; in such cases combination of ablation with PMMA injection and further augmentation with metallic instruments has shown promising preliminary results [56–58].
Ablation in the spinal column
As previously mentioned, due to weight bearing, ablation in the spinal column should be accompanied by cement augmentation. Another critical issue is the presence of nearby critical structures which are sensitive to extremely high or low temperatures. During ablation in the spinal column the temperature close to nerve roots and inside the spinal canal increases despite the decreased heat transmission by the cancellous and cortical bone [59]. Heating nervous tissue at 45 °C for 10.8 min has been shown to cause 50 % damage which is more extensive as the time and temperature increase, and the same is valid for peripheral nerves as well [60, 61]. Heat transfer due to ablation in the spine is affected by the active tip of the ablation device, the ablation protocol and the presence of intact bone cortex [62, 63]. Extreme cold during cryoablation can also result in neural damage with temporary neuropraxia occurring at −20 °C and permanent neurologic damage at ≤−40 °C [5]. Due to the sensitivity of nerves in extremely high or low temperatures and their proximity to ablation zone when spine is involved it seems rational to use all necessary and available protective techniques. These techniques include the use of thermo sensors for temperature measurement and the use of electrostimulation, evoked potentials or other monitoring techniques for the evaluation of nerve function during ablation session [5, 14, 64]. In addition, room air or carbon dioxide can be used to displace nontarget structures. Carbon dioxide is preferable since its higher solubility and its lower thermal conductivity can act as an excellent insulator in addition to increasing the distance between the ablation zone and sensitive structures. The combination of gas dissection and continuous temperature measurement close to sensitive structures is a safe and cost-effective technique which can increase the number of lesions to be treated by percutaneous imaging-guided approaches [65]. In addition, when skin is close to the expected ablation zone, increase in the distance can be achieved by local anesthetic or 5 % dextrose injection in the subcutaneous tissues and extra care can be performed by placement of a sterile glove containing warm or cold normal saline depending on the ablation technique.
Conclusions
Percutaneous imaging-guided ablation techniques include chemical ablation (injection of ethanol or acetic acid) and thermal ablation by means of energy deposition (radiofrequency or microwave ablation, coblation, cryoablation, laser ablation, high-intensity focused ultrasound). Imaging guidance improves visualization of the lesion and enhances exact positioning of the ablation device thus resulting in high technical and clinical efficacy rates as well as low potential complication rates. Anesthesiologic control, extended local sterility measures and prophylactic antibiosis constitute prerequisites. Percutaneous ablation techniques in bone lesions constitute curative therapies in benign tumors and oligometastatic disease; specifically for osteoid osteoma thermal ablation is considered the method of choice. In addition, percutaneous ablation techniques can be proposed as palliative therapies aiming at pain reduction and tumor decompression. Depending on lesion location, ablation can be combined with cementation with or without further metallic augmentation; local tumor control can be enhanced by combining ablation with transarterial bland embolization or chemoembolization. Protective techniques are optional but should be used to avoid iatrogenic damage of surrounding sensitive or critical structures whenever these structures are at risk close to the ablation zone.
References
Brown DB (2011) Musculoskeletal ablation. In: Hong K, Georgiades CS (eds) Percutaneous tumor ablation. Thieme, Strategies and Techniques, pp 137–152
Lutz S, Chowb E (2012) A review of recently published radiotherapy treatment guidelines for bone metastases: contrasts or convergence? J Bone Oncol 1:18–23. doi:10.1016/j.jbo.2012.04.002
Frassica DA (2003) General principles of external beam radiation therapy for skeletal metastases. Clin Orthop Relat Res 415:S158–S164
Franchi A (2012) Epidemiology and classification of bone tumors. Clin Cases Miner Bone Metab 9:92–95
Gangi A, Tsoumakidou G, Buy X, Quoix E (2010) Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol 33:706–713. doi:10.1007/s00270-009-9738-9
Kelekis AD, Somon T, Yilmaz H et al (2005) Interventional spine procedures. Eur J Radiol 55:362–383
Gangi A, Buy X (2010) Percutaneous bone tumor management. Semin Intervent Radiol 27:124–136. doi:10.1055/s-0030-1253511
Rosenthal D, Callstrom MR (2012) Critical review and state of the art in interventional oncology: benign and metastatic disease involving bone. Radiology 262:765–780. doi:10.1148/radiol.11101384
Kurup AN, Callstrom MR (2010) Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Intervent Radiol 27:276–284. doi:10.1055/s-0030-1261786
Kurup AN, Callstrom MR (2010) Ablation of skeletal metastases: current status. J Vasc Interv Radiol 21:S242–S250. doi:10.1016/j.jvir.2010.05.001
Napoli A, Anzidei M, Marincola BC (2013) MR imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics 33:1555–1568. doi:10.1148/rg.336125162
Tsoumakidou G, Buy X, Garnon J, Gangi A (2011) Tumor thermal ablation: insulation and temperature monitoring. Scientific Exhibit ESR. doi:10.1594/ecr2011/C-2281
Filippiadis DK, Mazioti A, Velonakis G et al (2013) Percutaneous image-guided ablation of bone and soft tissue tumors: how to avoid complications. Scientific Exhibit ESSR 2013. DOI: 10.1594/essr2013/P-0127
Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A (2013) Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol 36:1624–1628. doi:10.1007/s00270-013-0641-z
Hong K, Georgiades CS (2011) Radiofrequency ablation: mechanism of action and devices In: Hong K and Georgiades CS (eds) Percutaneous tumor ablation. Strategies and Techniques. Thieme1-14
Wolf F, Dupuy DE (2011) Microwave ablation: mechanism of action and devices. In: Hong K, Georgiades CS (eds) Percutaneous tumor ablation. Thieme, Strategies and Techniques, pp 27–43
Lubner MG, Brace CL, Hinshaw JL, Lee FT Jr (2010) Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 21:S192–S203. doi:10.1016/j.jvir.2010.04.007
Georgiades CS, Marx JK (2011) Cryoablation: mechanism of action and devices. In: Hong K, Georgiades CS (eds) Percutaneous tumor ablation. Thieme, Strategies and Techniques, pp 15–26
Boscainos PJ, Cousins GR, Kulshreshtha R et al (2013) Osteoid osteoma. Orthopedics 36:792–800. doi:10.3928/01477447-20130920-10
Frassica FJ, Waltrip RL, Sponseller PD et al (1996) Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am 27:559–574
Gitelis S, Schajowicz F (1989) Osteoid osteoma and osteoblastoma. Orthop Clin North Am 20:313–325
Rosenthal DI, Springfield DS, Gebhardt MC et al (1995) Osteoid osteoma: percutaneous radio-frequency ablation. Radiology 197:451–454
Rosenthal D, Hornicek FJ, Wolfe MW et al (1999) Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am 81:437–438
Mahnken AH, Tacke JA, Wildberger JE, Günther RW (2006) Radiofrequency ablation of osteoid osteoma: initial results with a bipolar ablation device. J Vasc Interv Radiol 17:1465–1470
Dasenbrock HH, Gandhi D, Kathuria S (2012) Percutaneous plasma mediated radiofrequency ablation of spinal osteoid osteomas. J Neurointerv Surg 4:226–228. doi:10.1136/neurintsurg-2011-010054
Kostrzewa M, Diezler P, Michaely H et al (2013) Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience. J Vasc Interv Radiol 25:106–111. doi:10.1016/j.jvir.2013.09.009
Basile A, Failla G, Reforgiato A et al (2013) The use of microwaves ablation in the treatment of epiphyseal osteoid osteomas. Cardiovasc Intervent Radiol. PMID:23989501
Gangi A, Alizadeh H, Wong L et al (2007) Osteoid osteoma: percutaneous laser ablation and follow-up in 114 patients. Radiology 242:293–301
Mahnken AH, Bruners P, Delbrück H, Günther RW (2011) Radiofrequency ablation of osteoid osteoma: initial experience with a new monopolar ablation device. Cardiovasc Intervent Radiol 34:579–584. doi:10.1007/s00270-010-9891-1
Mylona S, Patsoura S, Galani P et al (2010) Osteoid osteomas in common and in technically challenging locations treated with computed tomography-guided percutaneous radiofrequency ablation. Skeletal Radiol 39:443–449. doi:10.1007/s00256-009-0859-7
Napoli A, Mastantuono M, Cavallo Marincola B et al (2013) Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment. Radiology 267:514–521. doi:10.1148/radiol.13120873
Lanza E, Thouvenin Y, Viala P et al (2013) Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting. Cardiovasc Intervent Radiol. [Epub ahead of print]. PMID:24337349
Maurer MH, Gebauer B, Wieners G et al (2012) Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: a cost comparison. Eur J Radiol 81:e1002–e1006. doi:10.1016/j.ejrad.2012.07.010
Ramnath RR, Rosenthal DI, Cates J et al (2002) Intracortical chondroma simulating osteoid osteoma treated by radiofrequency. Skeletal Radiol 31:597–602
Corby RR, Stacy GS, Peabody TD, Dixon LB (2008) Radiofrequency ablation of solitary eosinophilic granuloma of bone. AJR Am J Roentgenol 190:1492–1494. doi:10.2214/AJR.07.3415
Cable BB, Mair EA (2001) Radiofrequency ablation of lymphangiomatous macroglossia. Laryngoscope 111:1859–1861
Tutton S, Olson E, King D, Shaker JL (2012) Successful treatment of tumor-induced osteomalacia with CT-guided percutaneous ethanol and cryoablation. J Clin Endocrinol Metab 97:3421–3425. doi:10.1210/jc.2012-1719
Becce F, Richarme D, Letovanec I et al (2012) Percutaneous radiofrequency ablation of primary intraosseous spinal glomus tumor. Skeletal Radiol 41:467–472. doi:10.1007/s00256-011-1308-y
Welch BT, Welch TJ (2011) Percutaneous ablation of benign bone tumors. Tech Vasc Interv Radiol 14:118–123. doi:10.1053/j.tvir.2011.02.003
Littrup PJ, Bang HJ, Currier BP et al (2013) Soft-tissue cryoablation in diffuse locations: feasibility and intermediate term outcomes. J Vasc Interv Radiol 24:1817–1825. doi:10.1016/j.jvir.2013.06.025
Lutz S, Chow E (2012) A review of recently published radiotherapy treatment guidelines for bone metastases: contrasts or convergence? J Bone Oncol 11:18–23. doi:10.1016/j.jbo.2012.04.002
Callstrom MR, Charboneau JW, Goetz MP et al (2002) Painful metastases involving bone: feasibility of percutaneous CT and US-guided radio-frequency ablation. Radiology 224:87–97
Masala S, Guglielmi G, Petrella MC et al (2011) Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series. Singapore Med J 52:182–189
Carrafiello G, Laganà D, Pellegrino C et al (2009) Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience. Radiol Med 114:608–625. doi:10.1007/s11547-009-0395-5
Carrafiello G, Laganà D, Ianniello A et al (2009) Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma. Eur J Radiol 71:363–368. doi:10.1016/j.ejrad.2008.04.019
Callstrom MR, Dupuy DE, Solomon SB et al (2013) Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 119:1033–1041. doi:10.1002/cncr.27793
Dupuy DE, Liu D, Hartfeil D et al (2010) Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American college of radiology imaging network trial. Cancer 116:989–997. doi:10.1002/cncr.24837
Goetz MP, Callstrom MR, Charboneau JW et al (2004) Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 22:300–306
Pusceddu C, Sotgia B, Fele RM, Melis L (2013) Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol 24:229–233. doi:10.1016/j.jvir.2012.10.009
Li C, Wu P, Zhang L et al (2009) Osteosarcoma: limb salvaging treatment by ultrasonographically guided high intensity focused ultrasound. Cancer Biol Ther 12:1102–1108
Alda T, Kamran A (2007) Palliative interventions for pain in cancer patients. Semin Intervent Radiol 24:419–429. doi:10.1055/s-2007-992330
Lee JH, Stein M, Roychowdhury S (2013) Percutaneous treatment of a sacral metastasis with combined embolization, cryoablation, alcohol ablation and sacroplasty for local tumor and pain control. Interv Neuroradiol 2:250–253
Munk PL, Murphy KJ, Gangi A, Liu DM (2011) Fire and ice: percutaneous ablative therapies and cement injection in management of metastatic disease of the spine. Semin Musculoskelet Radiol 15:125–134. doi:10.1055/s-0031-1275595
van der Linden E, Kroft LJ, Dijkstra PD (2007) Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients. J Vasc Interv Radiol 18:741–747
Ahn H, Mousavi P, Chin L et al (2007) The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine. Eur Spine J 16:1171–1178
Abdel-Aal AK, Underwood ES, Saddekni S (2012) Use of cryoablation and osteoplasty reinforced with Kirschner wires in the treatment of femoral metastasis. Cardiovasc Intervent Radiol 35:1211–1215
Deschamps F, Farouil G, Hakime A et al (2012) Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 35:1428–1432. doi:10.1007/s00270-011-0330-8
Anselmetti GC, Manca A, Chiara G et al (2011) Painful pathologic fracture of the humerus: percutaneous osteoplasty with bone marrow nails under hybrid computed tomography and fluoroscopic guidance. J Vasc Interv Radiol 22:1031–1034. doi:10.1016/j.jvir.2011.02.021
Dupuy DE, Hong R, Oliver B, Goldberg SN (2000) Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. Am J Roentgenol AJR 175:1263–1266
Froese G, Das RM, Dunscombe PB (1991) The sensitivity of the thoracolumbar spinal cord of the mouse to hyperthermia. Radiat Res 125:173–180
Letcher FS, Goldring S (1968) The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg 29:42–47
Adachi A, Kaminou T, Ogawa T et al (2008) Heat distribution in the spinal canal during radiofrequency ablation for vertebral lesions: study in swine. Radiology 247:374–380. doi:10.1148/radiol.2472070808
Nakatsuka A, Yamakado K, Maeda M et al (2004) Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 15:707–712
Diehn FE, Neeman Z, Hvizda JL et al (2003) Remote thermometry to avoid complications in radiofrequency ablation. J Vasc Interv Radiol 14:1569–1576
Buy X, Tok CH, Szwarc D et al (2009) Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol 32:529–534. doi:10.1007/s00270-009-9524-8
Rosenthal DI, Treat ME, Mankin HJ, Rosenberg AE, Jennings CL (2001) Treatment of epithelioid hemangioendothelioma of bone using a novel combined approach. Skeletal Radiol 30(4):219–222
Conflict of interest
The Authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Filippiadis, D.K., Tutton, S. & Kelekis, A. Percutaneous bone lesion ablation. Radiol med 119, 462–469 (2014). https://doi.org/10.1007/s11547-014-0418-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-014-0418-8