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Percutaneous Image-Guided Cryoablation Of Osteoblastic Metastatic Lesions 2013

Category Interventional Travis Hillen
Louis Gilula
Jack Jennings
Purpose Osteoblastic spine lesions commonly cause back pain that is difficult to treat.  In general, painful blastic metastatic bone lesions are often refractory to hormonal therapy and chemotherapy.  External beam radiation therapy often achieves only transient pain relief.  Due to the high impedance values seen in blastic lesions, radiofrequency ablation is ineffective.  Percutaneous image-guided cryoablation has shown efficacy in the treatment of lytic metastatic bone lesions and is not restricted by tissue impedance.  Treatment of blastic metastases has not yet been widely recognized.  The purpose of this study is to demonstrate the safety and efficacy of percutaneous cryoablation in the reduction of pain and analgesic medication use related to blastic metastatic osseous lesions. Materials & Methods Eight patients with a total of 14 painful osteoblastic lesions underwent image-guided cryoablation.  Lesion etiology included breast, lung, osteosarcoma, and pancreatic metastatic lesions.  Three lesions involved the spine (1 thoracic and 2 lumbar); others involved the pubic rami, ilium, clavicle, and tibia.  6 of the 8 patients received radiation therapy without pain relief.  The initial and post-procedure Visual Analog Pain Scale (VAS) value, Brief Pain Inventory (BPI) and analgesic use histories were recorded.  At least one freeze-thaw-freeze cycle was performed on each lesion with cryoprobes.  Special neural thermal protection techniques involving epidural or neuroforaminal injection of CO2 or warmed fluid were used in some cases. Results There were no serious complications.  One patient with a treated supra-acetabular lesion has nearly resolved right lower extremity weakness.  Pain levels were assessed immediately before the procedure and up to 6 months following using VAS scores on all and BPI on most.  All patients reported relief of pain with decreased VAS scores and decreased use of analgesics. Conclusion In the treatment of blastic metastatic lesions of the spine, as well as other osseous sites, percutaneous image-guided cryoablation is safe and effective in reducing pain and analgesic medication use.  In all cases, this technique allowed for the treatment of individual lesions not controlled by systemic or radiation therapy.  Currently, cryotherapy may be the only method to relieve pain in such patients. References 1. de Freitas RM, de Menezes MR, Cerri GG, Gangi A. Sclerotic vertebral metastases: pain palliation using percutaneous image-guided cryoablation. Cardiovasc Intervent Radiol 2011;34 Suppl 2: S294-9. 2. Callstrom MR, Atwell TD, Charboneau JW, et al. Painful metastases involving bone: percutaneous image-guided cryoablation--prospective trial interim analysis. Radiology 2006;241(2): 572-80. Fig. 1. CT image demonstrates multiple osteoblastic metastatic lesions (non-small cell lung cancer). Fig. 2-4. Fluoroscopic images during cryoablation of the L4 lesion. Submission previously published or presented: No