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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 10 mars 2019
Doi : 10.1016/j.otsr.2019.01.001
Received : 19 December 2017 ;  accepted : 7 January 2019
Percutaneous image-guided cryoablation of painful bone metastases: A single institution experience
 

Nicolas Gallusser 1, Patrick Goetti 1, Fabio Becce, Frédéric Vauclair, Hannes A. Rüdiger, Pierre E. Bize, Stéphane Cherix
 Lausanne University Hospital, 46, rue du Bugnon, CH-1011 Lausanne, Switzerland 

Corresponding author. Service d’orthopédie et de traumatologie, Département de l’appareil locomoteur, Lausanne University Hospital, 46, rue du Bugnon, CH-1011 Lausanne, Switzerland.Switzerland
Abstract
Background

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.

Materials and methods

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.

Results

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.

Conclusion

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.

Level of evidence

IV, Retrospective case series.

The full text of this article is available in PDF format.

Keywords : Bone metastases, Cryoablation, Percutaneous therapy, Pain, Local disease control


1  N. Gallusser and P. Goetti contributed equally to this work.


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