Radiofrequency Ablation Combined with Augmentation for Local Tumor Control of Skeletal Metastases

Presentation Format: Oral presentation.

Purpose or Learning Objective: Percutaneous radiofrequency ablation (RFA) combined with augmentation has emerged as a minimally invasive treatment for patients with painful skeletal metastases who do not respond to or have contraindications to radiation therapy. This study evaluated the incidence of tumor recurrence following RFA using bipolar electrodes combined with cement augmentation of skeletal metastases.

Methods or Background: A retrospective review was performed of 33 image-guided RFA procedures performed on 21 patients following multidisciplinary consultations between 2018 and 2020. Tumor characteristics, procedural details, and complications were documented and analyzed. Pre- and postprocedural cross-sectional imaging was evaluated to assess local tumor control rates.

Results or Findings: A total of 33 ablation procedures performed in 21 patients: 13 men (mean age: 67 years; range: 41–87 years) and 8 women (mean age: 54 years; range: 42–76 years) were included. Primary tumors included breast cancer, cholangiocarcinoma, gastrointestinal adenocarcinoma, small cell lung cancer, non–small cell lung cancer, lymphoma, melanoma, myeloma, prostate cancer, renal cell carcinoma, and urothelial cell carcinoma. Ablation procedures were performed within the thoracic spine (n = 8), lumbar spine (n = 18), and pelvis (n = 7). Postprocedure imaging was available for 18 patients. Local tumor control was achieved in 83% (15/18) of tumors with a median imaging follow-up of 65 days, although disease progression was often identified at distant sites on postprocedure imaging. Local tumor progression was demonstrated in 17% (3/18) of cases at the margins of the ablation zone. Regression of epidural tumor at the posterior margin of the ablation zone was achieved in 5% (1/18). No complications, adverse events, or fractures were reported. In patients with vertebral metastases, no patients had clinical evidence of metastatic spinal cord compression at the treated levels.

Conclusion: RFA combined with cement augmentation is safe and effective for local tumor control of metastases. This combined approach may lead to more effective pain palliation, prevent local disease progression, reduce the risk of pathologic fractures, and thus reduce the risk of metastatic spinal cord compression.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 June 2021