Percutaneous image-guided cryoablation of painful bone metastases: A single institution experience

Bone metastases are frequently painful and may lead to various complications that can affect quality of life. While external beam radiation therapy is the standard first-line treatment, 20-30% of patients do not experience sufficient pain relief. Cryoablation is increasingly being used for the treatment of musculoskeletal metastases. The purpose of our retrospective study was to analyze pain relief and local disease control after percutaneous image-guided cryoablation (PCA) therapy of painful bone metastases.

Sixteen patients treated with PCA for painful bone metastases (n=18) over a 5-year period (from June 2011 to June 2016) were retrospectively reviewed. Five patients also benefited from long bone fixation because of an impending fracture. We analyzed the impact of treatment on pain relief, using a numerical rating scale (NRS), and local disease control.

The mean follow-up period was 12 months (range, 1.5-39 months). At last oncological outpatient consultation, 75% (12/16) of patients had good pain relief, while 63% (10/16) had locally stable disease or no local recurrence of the treated bone metastases. The mean NRS score decreased significantly from 3.3 to 1.2 after PCA (p=0.0024). The five patients with concomitant long bone fixation all had satisfactory pain relief at the last follow-up visit.

PCA is a safe and valid treatment option for pain and local disease control in cases of painful bone metastases after failed standard first-line therapy. This technique can also be effectively associated to prophylactic long bone fixation and may allow for easier rehabilitation protocols when treating weight-bearing bones.

IV, Retrospective case series.