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Painful Metastases Involving Bone: Feasibility of Percutaneous CT- and US-guided Radio-frequency Ablation¹

¹ From the Departs of Radiology (M.R.C., J.W.C., B.D.L., T.J.W., M.A.F., T.P.M., R.A.L., C.C.R., D.D.P.), Oncology (M.P.G., J.R.), Anesthesiology (G.Y.W.), Biostatistics (J.A.S., P.J.N.), and Radiation Oncology (I.A.P.), Mayo Clinic, 200 First St SW, E2, Rochester, MN 55905. Received October 1, 2001; revision requested Dec 11; revision received Jan 15, 2002; accepted Feb 28. Supported in part by RITA Medical Systems, Mountain View, Calif. Address correspondence to J.W.C. (e-mail: charboneau.william@mayo.edu).

View larger version (44K): [in a new window]   Figure 1. Graphs show worst pain over 24 hours for patients treated with RF ablation, as measured with the BPI. Data for week 0 represent the baseline (pretreatment) measurement. Top: Mean responses for all patients. Error bars = 95% CIs, N = number of patients completing BPI at each time point. Bottom: Individual responses for each patient.

View larger version (40K): [in a new window]   Figure 2. Graphs show average pain for patients treated with RF ablation, as measured with the BPI. Data for week 0 represent the baseline (pretreatment) measurement. Top: Mean responses for all patients. Error bars = 95% CIs, N = number of patients completing the BPI. Bottom: Individual responses for each patient.

View larger version (48K): [in a new window]   Figure 3. Graphs show interference of pain in daily activities for patients treated with RF ablation. Data for week 0 represent the baseline (pretreatment) measurement. Top: Mean responses for all patients. Error bars = 95% CIs, N = number of patients completing the BPI. Bottom: Individual responses for each patient.

View larger version (45K): [in a new window]   Figure 4. Graphs show relief due to pain treatments or medications in patients treated with RF ablation. Data for week 0 represent the baseline (pretreatment) measurement. Top: Mean responses for all patients. Error bars = 95% CIs, N = number of patients completing the BPI. Bottom: Individual responses for each patient.

View larger version (146K): [in a new window]   Figure 5. Patient 1. Transverse CT image obtained at the level of the acetabuli with the patient prone. A percutaneously placed RF electrode (arrow) was deployed in an osseous and soft-tissue renal cell carcinoma metastatic lesion involving the medial and posterior wall of the left acetabulum. Before RF ablation, the patient’s average pain score 8. At 4, 6, and 8 weeks after RF ablation, the average pain score was 5, 1, and 0, respectively. The patient died 6 weeks after 6-month follow-up, with no pain at the treated site.

View larger version (104K): [in a new window]   Figure 6. Patient 4. Transverse three-dimensional volume CT images obtained at the level of the sacrum with the patient prone show four of 14 percutaneously placed RF electrode deployments (arrows) in an osseous and soft-tissue colorectal carcinoma metastatic lesion diffusely involving the sacrum. Before RF ablation, the average pain score was 8. At 4, 6, and 8 weeks after ablation, the average pain score was 3, 2, and 1, respectively. At 6 months after ablation, the reported average pain score was 0.

View larger version (115K): [in a new window]   Figure 7. Patient 11. Transverse three-dimensional volume CT images obtained at the level of the sacrum with the patient prone show a percutaneously placed RF electrode (arrows) deployed in an osseous and soft-tissue renal cell carcinoma metastatic lesion diffusely involving the left iliac bone (A) and in a soft-tissue lesion involving gluteal musculature of the left buttock (B). The soft-tissue lesion corresponded to the site of patient’s greatest pain. Before RF ablation, the average pain score was 5. At both 4 and 6 weeks after ablation, the average score was 0. This patient died 7 weeks after RF ablation, with no pain at the treated site.

View larger version (74K): [in a new window]   Figure 8. Patient 3. Transverse contrast-enhanced CT images with patient supine show metastatic small cell lung carcinoma lesion (arrows) involving a rib, body wall, and underlying liver. A, Immediately before RF ablation, the mass shows partial enhancement. B, At 1 week after ablation, the mass is hypovascular, which is consistent with necrosis. C, At 12 weeks after ablation, the necrotic mass shows interval decrease in size. Before ablation, the average pain score was 5. At 4, 6, and 8 weeks after ablation, the average pain score was 1. At 6 months after ablation, the reported average pain score was 0.

View larger version (127K): [in a new window]   Figure 9. Patient 9. Transverse CT images obtained with the patient prone. A, Three-dimensional volume unenhanced image shows RF electrode (arrow) placed into a colorectal carcinoma metastatic lesion involving a vertebral body, rib, and adjacent pleural surface, with a thermocouple (arrowhead) placed in the region of the lateral margin of a largely destroyed left pedicle. B, Contrast-enhanced image of the same region, obtained 1 week after RF ablation, demonstrates a low-attenuating area (arrow), consistent with necrosis, in the paravertebral soft tissues, corresponding to the ablated region. Before ablation, the average pain score was 9. At 4, 6, and 8 weeks after ablation, the average pain score was 3, 4, and 3, respectively. At latest follow-up (16 weeks after ablation), the reported average pain score was 0.