Cryoablation versus Radiofrequency Ablation for the Treatment of Osteoid Osteoma

To explore the safety and effectiveness of cryoablation versus radiofrequency ablation (RFA) for the treatment of primary and recurrent osteoid osteomas (OOs) and to explore predictors of success.

All thermal ablations of OOs were retrospectively reviewed at a single institution, comprising 99 consecutive treatments (57 RFAs and 42 cryoablations) in 93 patients (male, 64; mean age, 17 years). Rates of technical success, clinical success, OO recurrence, and curative response were calculated and compared between groups. Predictors of outcomes were analyzed using binary logistic regression.

Technical success was achieved in all but 1 patient. Of the 92 technically successful first-time ablations, clinical success was achieved in 87 patients (95%) in the overall cohort, 93% (51/55) of those who underwent RFA, and 97% (36/37) of those who underwent cryoablation (P = .343). OO recurrence occurred in 6 (7%) of 87 clinically successful ablations, with 10% (5/51) in the RFA group and 3% (1/36) in the cryoablation group (P = .202). The curative response rate after one or two ablations without requiring surgery was 97% (88/92). Six patients underwent thermal ablation of a residual or recurrent OO, with 5 achieving a curative response (83%). No significant predictors of clinical success, OO recurrence, or curative response were identified. One major and one moderate adverse events were identified, both after cryoablation.

Both cryoablation and RFA have a high curative response rate and excellent safety for the primary and secondary treatment of OO. No factors were identified to predict failed responses.