Radiofrequency ablation relieved pain in patients with metastatic bone disease
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Radiofrequency ablation yielded a rapid and statistically significant improvement in pain relief among patients with metastatic bone disease, according to published results.
Jason Levy, MD, Sandeep Bagla, MD, and colleagues measured pain and quality of life among 100 patients with metastatic bone disease who underwent radiofrequency ablation (OsteoCool RF Ablation System, Sofamor Danek/Medtronic) preoperatively and at 3 days, 1 week, and 1, 3 and 6 months postoperatively. Researchers also collected opioid agent use and device-, procedure- and therapy-related adverse events.
Results showed a decrease in mean worst pain score from approximately 8.2 at baseline to 3.5 at 6 months postoperatively. Researchers found significant improvements in average pain relief, pain interference and quality of life at all follow-up visits.
“As early as 3 days post-procedure, well more than half of the patients were already seeing pain relief and quality of life improvements and that was sustained when we followed these patients up for 6 months,” Levy, interventional radiologist at Northside Hospital System, told Healio Orthopedics.
Levy also noted patients did not experience a delayed skeletal event, such as a neurologic or osseous injury.
“[Delayed skeletal events], especially the fractures, are reported in radiation,” Levy said. “In our first 100 patients, we did not see it once, so that is encouraging from a safety perspective.”
Researchers noted four adverse events occurred, two of which resulted in hospitalization for pneumonia and respiratory failure. According to results, 30 deaths were reported during the study; however, researchers noted these were not related to the procedure but attributed to the underlying malignancy.
“The most significant takeaway from the study is that patients can receive an immediate response in terms of pain and function [with radiofrequency ablation] as opposed to with other therapies, such as radiation, which may take a more prolonged time to response, closer to 4 to 6 weeks,” Bagla told Healio Orthopedics. “With such high response rates, rapid time to improvement and minimally invasive nature, radiofrequency ablation is set to join other historic therapies in national societal guidelines.”
Perspective
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Metastatic bone lesions are often severely painful and debilitating, with some cases leading to fracture and, in cases of the spine, neurologic involvement. Although there have been advancements in the prevention of bone involvement with bisphosphonates and external beam radiation, pursuing alternate non-surgical options can be extremely beneficial, especially in the axial skeleton. The OsteoCool RF Ablation System appears to be a promising minimally invasive non-surgical alternative.
The benefits of image-guided radiofrequency ablation have been well studied for decades in the treatment of osteoid osteoma and other benign tumors and has proven great success. This study of 134 ablation procedures in 100 patients treated at 14 global cancer centers is sufficient to determine whether patients were achieving significant benefit from treatment. Exceptional results were noted in this study, which showed rapid and significant pain relief which translates to improved quality of life. Furthermore, sustained pain relief was also reported with a minimum of 6 months follow-up.
It’s important to emphasize that this study only included patients without a prior history of radiation, no post procedural fractures and that there was no polymethyl methacrylate augmentation leakage. This appears to be an important option in our armamentarium to treat axial skeletal bone metastasis.
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