Percutaneous tumor ablation techniques for palliative cancer pain: a narrative review

Cancer-related pain remains a prevalent and debilitating symptom in patients with advanced malignancy, often inadequately controlled with systemic analgesics, radiotherapy, or surgery due to limited efficacy, delayed onset, or treatment-related toxicity. Percutaneous image-guided tumor ablation has emerged as a minimally invasive option capable of providing effective pain palliation while preserving quality of life. The objective of this narrative review is to summarize and critically appraise tumor ablation techniques relevant to palliative and interventional pain care, with particular focus on analgesic outcomes, mechanisms of pain relief, and clinical applicability.

A narrative literature review was conducted using PubMed, Scopus, and Embase to identify English-language studies published between 2000 and 2025 evaluating percutaneous tumor ablation for cancer-related pain. Search terms included radiofrequency ablation, microwave ablation, cryoablation, laser ablation, irreversible electroporation, high-intensity focused ultrasound, and cancer pain. Priority was given to recent systematic reviews and key clinical studies published between 2023 and 2025.

The review encompasses both thermal (radiofrequency, microwave, cryoablation, and laser) and non-thermal [irreversible electroporation (IRE)] ablation modalities. Across the literature, tumor ablation is associated with meaningful reductions in pain intensity, decreased opioid requirements, and improvements in functional status and quality of life. Radiofrequency (RFA) and microwave ablation (MWA) are commonly utilized for painful bone and soft-tissue metastases, while cryoablation offers improved visualization and is preferred for lesions in proximity to neural or critical structures. Laser ablation and IRE may be advantageous when thermal injury is a concern. When performed with appropriate imaging guidance and patient selection, reported complication rates are low. Emerging approaches, including bipolar RFA, often combined with vertebral augmentation, have demonstrated particular benefit in painful spinal metastases.

Percutaneous tumor ablation represents a valuable adjunct in multidisciplinary palliative pain management. By synthesizing current evidence, this review may assist clinicians in selecting appropriate ablative strategies, support earlier integration of minimally invasive interventions into palliative care pathways, and inform future research focused on standardized pain outcomes, comparative effectiveness, and guideline development.