Skip to main content

Advertisement

SpringerLink
Log in

Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: preliminary results in 11 patients

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the safety and effectiveness of radiofrequency ablation (RFA) to treat sacral metastases for pain palliation and local tumor control (LTC).

Materials and Methods

An institutional tumor ablation registry was retrospectively reviewed for sacral RFA procedures performed between January 2012 and December 2015. Clinical history, pre-procedural imaging, and procedural details were reviewed to document indication for treatment, primary tumor histology, tumor volumes, presence of concurrent cementoplasty after RFA, and the occurrence of peri-procedural complications. Pain scores before and 4 weeks after the procedure were recorded. Post-procedure imaging was reviewed for imaging evidence of tumor progression. Long-term complications and duration of clinical follow-up were recorded.

Results

During the study period, 11 RFA procedures were performed to treat 16 sacral metastases. All procedures were for pain palliation. Four procedures (36 %; 4 out of 11) were also performed with the intention of achieving LTC in patients with oligometastatic disease. Concurrent cementoplasty was performed in 63 % of cases (7 out of 11). The median pain score decreased from 8 (interquartile range, 6–9.25) at baseline to 3 (interquartile range, 1.75–6.3) 1 month following RFA (P = 0.004). In the 4 patients with oligometastatic disease, LTC was achieved in 3 patients (75 %; 3 out of 4) after a median follow-up of 7.6 months (range, 3.6–11.9 months). No acute or long-term complications were documented during the overall median clinical follow-up of 4.7 months (range, 0.9–28.7 months).

Conclusions

Radiofrequency ablation maybe a safe and potentially effective treatment for patients with painful sacral metastases and can achieve LTC in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nader R, Rhines LD, Mendel E. Metastatic sacral tumors. Neurosurg Clin N Am. 2004;15(4):453–7.

    Article  PubMed  Google Scholar 

  2. Finiels H, Finiels P, Jacquot J, Strubel D. Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases. Presse Med (Paris, France: 1983). 1997;26(33):1568–73.

  3. Kortman K, Ortiz O, Miller T, Brook A, Tutton S, Mathis J, et al. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg. 2013;5(5):461–6.

    Article  PubMed  Google Scholar 

  4. Ollila DW, Gleisner AL, Hsueh EC. Rationale for complete metastasectomy in patients with stage IV metastatic melanoma. J Surg Oncol. 2011;104(4):420–4.

    Article  PubMed  Google Scholar 

  5. Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, et al. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys. 2004;58(1):3–10.

    Article  PubMed  Google Scholar 

  6. Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol Off J Am Soc Clin Oncol. 2004;22(2):300–6.

    Article  Google Scholar 

  7. Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous metastases. Cancer. 2010;116(4):989–97.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Munk PL, Rashid F, Heran MK, Papirny M, Liu DM, Malfair D, et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol. 2009;20(7):903–11.

    Article  PubMed  Google Scholar 

  9. Lane MD, Le HB, Lee S, Young C, Heran MK, Badii M, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skelet Radiol. 2011;40(1):25–32.

  10. Hoffmann RT, Jakobs TF, Trumm C, Weber C, Helmberger TK, Reiser MF. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. J Vasc Interv Radiol. 2008;19(3):419–25.

    Article  PubMed  Google Scholar 

  11. Toyota N, Naito A, Kakizawa H, Hieda M, Hirai N, Tachikake T, et al. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol. 2005;28(5):578–83.

    Article  PubMed  Google Scholar 

  12. Monga SP, Wadleigh R, Sharma A, Adib H, Strader D, Singh G, et al. Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer. Am J Clin Oncol. 2000;23(4):386–92.

    Article  CAS  PubMed  Google Scholar 

  13. Wallace AN, Greenwood TJ, Jennings JW. Use of imaging in the management of metastatic spine disease with percutaneous ablation and vertebral augmentation. Am J Roentgenol. 2015;205(2):434–41.

    Article  Google Scholar 

  14. Wu JS-Y, Wong R, Johnston M, Bezjak A, Whelan T, Group CCOPGISC. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003;55(3):594–605.

    Article  PubMed  Google Scholar 

  15. Agarawal J, Swangsilpa T, Van der Linden Y, Rades D, Jeremic B, Hoskin P. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol. 2006;18(10):747–60.

    Article  CAS  Google Scholar 

  16. Blomlie V, Rofstad E, Talle K, Sundfør K, Winderen M, Lien H. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol. 1996;167(5):1205–10.

    Article  CAS  PubMed  Google Scholar 

  17. Stinauer MA, Kavanagh BD, Schefter TE, Gonzalez R, Flaig T, Lewis K, et al. Stereotactic body radiation therapy for melanoma and renal cell carcinoma: impact of single fraction equivalent dose on local control. Radiat Oncol. 2011;6:34.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Khan AJ, Mehta S, Zusag TW, Bonomi PD, Faber LP, Shott S, et al. Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC). Radiother Oncol. 2006;81(2):163–7.

    Article  PubMed  Google Scholar 

  19. Miles WK, Chang DW, Kroll SS, Miller MJ, Langstein HN, Reece GP, et al. Reconstruction of large sacral defects following total sacrectomy. Plast Reconstr Surg. 2000;105(7):2387–94.

    Article  CAS  PubMed  Google Scholar 

  20. Thanos L, Mylona S, Galani P, Tzavoulis D, Kalioras V, Tanteles S, et al. Radiofrequency ablation of osseous metastases for the palliation of pain. Skeletal Radiol. 2008;37(3):189–94.

    Article  CAS  PubMed  Google Scholar 

  21. Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neuro-Oncol. 2015;124(1):111–8.

    Article  Google Scholar 

  22. Yano T, Okamoto T, Haro A, Fukuyama S, Yoshida T, Kohno M, et al. Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer. Lung Cancer. 2013;82(3):431–5.

    Article  PubMed  Google Scholar 

  23. MacDermed DM, Weichselbaum RR, Salama JK. A rationale for the targeted treatment of oligometastases with radiotherapy. J Surg Oncol. 2008;98(3):202–6.

    Article  PubMed  Google Scholar 

  24. McMenomy BP, Kurup AN, Johnson GB, Carter RE, McWilliams RR, Markovic SN, et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol. 2013;24(2):207–13.

    Article  PubMed  Google Scholar 

  25. Wallace A, Tomasian A, Vaswani D, Vyhmeister R, Chang R, Jennings J. Radiographic local control of spinal metastases with percutaneous radiofrequency ablation and vertebral augmentation. Am J Neuroradiol. 2015;37(4):759–65.

  26. Anchala PR, Irving WD, Hillen TJ, Friedman MV, Georgy BA, Coldwell DM, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician. 2014;17(4):317.

    PubMed  Google Scholar 

  27. Hillen TJ, Anchala P, Friedman MV, Jennings JW. Treatment of metastatic posterior vertebral body osseous tumors by using a targeted bipolar radiofrequency ablation device: technical note. Radiology. 2014;273(1):261–7.

    Article  PubMed  Google Scholar 

  28. Moussazadeh N, Laufer I, Werner T, Krol G, Boland P, Bilsky MH, et al. Sacroplasty for cancer-associated insufficiency fractures. Neurosurgery. 2015;76(4):446–50. discussion 450.

    Article  PubMed  Google Scholar 

  29. Pereira LP, Clarencon F, Cormier E, Rose M, Jean B, Le Jean L, et al. Safety and effectiveness of percutaneous sacroplasty: a single-centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance. Eur Radiol. 2013;23(10):2764–72.

    Article  PubMed  Google Scholar 

  30. Halpin RJ, Bendok BR, Sato KT, Liu JC, Patel JD, Rosen ST. Combination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report. Surg Neurol. 2005;63(5):469–74.

    Article  PubMed  Google Scholar 

  31. Schaefer O, Lohrmann C, Herling M, Uhrmeister P, Langer M. Combined radiofrequency thermal ablation and percutaneous cementoplasty treatment of a pathologic fracture. J Vasc Interv Radiol. 2002;13(10):1047–50.

    Article  PubMed  Google Scholar 

  32. Georgy B, Wong W. Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures. Am J Neuroradiol. 2007;28(4):700–5.

    CAS  PubMed  Google Scholar 

  33. Baque P, Karimdjee B, Iannelli A, Benizri E, Rahili A, Benchimol D, et al. Anatomy of the presacral venous plexus: implications for rectal surgery. Surg Radiol Anat. 2004;26(5):355–8.

    Article  CAS  PubMed  Google Scholar 

  34. Wallace AN, Vyhmeister R, Hsi AC, Robinson CG, Chang RO, Jennings JW. Delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation: case report with histopathologic–MRI correlation. Interv Neuroradiol. 2015;1(6):742–9.

  35. Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin N Am. 2000;31(4):515–28.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO, 63110, USA

    Thomas P. Madaelil, Adam N. Wallace & Jack W. Jennings

Authors
  1. Thomas P. Madaelil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam N. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jack W. Jennings
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas P. Madaelil.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

The treating physician obtained informed consent before each procedure. The local institutional review board provided an exemption for collecting additional informed consent after the initial procedure, given the retrospective nature of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madaelil, T.P., Wallace, A.N. & Jennings, J.W. Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: preliminary results in 11 patients. Skeletal Radiol 45, 1213–1219 (2016). https://doi.org/10.1007/s00256-016-2404-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2404-9

Keywords

Search

Navigation