Review article
Ablation of Skeletal Metastases: Current Status

https://doi.org/10.1016/j.jvir.2010.05.001Get rights and content

Image-guided percutaneous ablation of bone metastases is an effective, minimally invasive alternative to conventional therapies in the palliation of pain from metastatic disease. Ablative technologies applied in the treatment of skeletal metastases include radiofrequency ablation, cryoablation, microwave ablation, laser ablation, ethanol ablation, and, most recently, focused ultrasound. These ablative methods may be performed in combination with percutaneous cementoplasty to provide support and stabilization for metastases in weight-bearing bones at risk for pathologic fracture.

Section snippets

Patient Selection and Preprocedural Considerations

Appropriate application of tumor ablative technology to the treatment of painful bone and soft tissue metastases begins with careful patient and lesion selection. The location and severity of pain should be determined by physical examination and through the use of validated pain scales. For palliation of symptomatic metastases, ablation should be reserved for patients experiencing at least moderate pain (≥ 4 on a 10-point scale for worst pain in a 24-hour period) because it is difficult to

Anatomic Considerations

Percutaneous ablation of bone metastases requires careful consideration of the perilesional anatomy. Proximity of critical structures influences patient selection and may also require use of additional techniques to protect and monitor these structures. The targeted metastasis must be accessible percutaneously and sufficiently separate from the central nervous system, major peripheral motor nerves, artery of Adamkiewicz, bowel, or bladder. Treatment planning should also consider the possible

Ablation Techniques

Various image-guided ablation technologies have been applied to the treatment of bone metastases with varied levels of published evidence. Thermal ablation methods include RF ablation, cryoablation, microwave ablation, laser ablation, and MR imaging–guided extracorporeal-focused ultrasound (MRgFUS). Additional percutaneous techniques applied to bone metastases include alcohol ablation and cementoplasty. The type of energy or material delivered, image-guidance methods, treatment monitoring, and

Conclusion

Image-guided percutaneous ablation of bone and soft tissue tumors offers a minimally invasive treatment approach, which is safe, effective, durable, and repeatable. Appropriate patient and tumor selection with necessary anatomic considerations are critical for effective, safe treatment of patients with metastatic disease. Several different ablative technologies have been applied successfully to the treatment of patients with metastatic disease involving the skeletal system and soft tissue

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    M.R.C. has research funded by RITA Medical Systems and Endocare Inc. A.N.K. has not identified a conflict of interest.

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