Study: Radiofrequency ablation may safely reduce bone metastasis pain

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Radiofrequency ablation (RFA) can possibly alleviate the intensity of pain brought on by bone metastases, according to a study published online Jan. 4 in Cancer.

A research team led by Damian Dupuy, MD, director of ablation services at Rhode Island Hospital and professor of diagnostic imaging at the Warren Alpert Medical School of Brown University in Providence, R.I., conducted a single-arm prospective trial to determine whether RFA can safely manage pain from osseous metastatic disease, as it has been proven successful in the treatment of liver, kidney and lung cancer tumor cases.

According to the authors, between 30 and 70 percent of all patients diagnosed with cancer each year will develop a bone metastasis. Narcotics are typically used for pain management of this condition inside the hospital, and the dose of these drugs must be increased as a patient undergoes this treatment, the study found.

However, the researchers noted that this form of treatment is not effective for all patients.

“It is clear that improved palliative treatments must be identified to address the needs of these great many patients,” said Dupuy. “RFA is widely available, covered by most insurance and often allows patients enhanced interaction with loved ones by reducing use of strong narcotics which can leave them in a medicated state. Also, unlike many other cancer pain management treatments, RFA can be repeated and maintain similar results.”

The study, sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), recruited 55 patients presenting with one bone metastasis with a chronic pain score of more than 50 on a pain scale of 0-100.

Each patient underwent percutaneous CT-guided RFA--which utilizes electrodes to generate heat and destroy abnormal cancer cells of the bone metastasis --at a temperature of less than 60°C. Patients were asked to note their pain levels daily for the first two weeks post-treatment and then once again at the one-month and three-month follow-up periods.

RFA was found to have reduced pain at the one- and three-month follow-up marks for all pain assessment measures. The authors noted that the average increase in pain relief from the pre-RFA to the one-month mark was 26.3 percent, and the increase from pre-RFA to the three-month mark was 16.38 percent.

Pain intensity from pre-RFA to the one-month follow up was found to have an average decrease of 26.9 percent and 14.2 percent at the three-month follow up, said the authors.

Additionally, the researchers noted that because RFA is minimally invasive and can be performed in the outpatient setting, the treatment may support patient frame of mind and mood. As a result, the authors found that the average mood increase in the patients rose 19.9 percent from pre-RFA treatments to the one-month mark, and 14.9 percent to the three-month follow up.

In five percent of the patients, grade 3 toxicities were reported. Despite these adverse events, the procedure was found to be a safe alternative for patients who previously received radiation therapy and have reached their maximum radiation dose, but are still experiencing pain, concluded the authors.

“We know that RFA is a highly effective cancer treatment when surgery is not an option,” said Dupuy. “RFA offers potential advantages over other methods in that cell death is immediate, lesion size can be accurately controlled, lesion temperature can be monitored, and it can be performed under local anesthesia and conscious sedation in the outpatient setting. This is a significant step forward in the pain management of these patients.”