Percutaneous Radio Frequency Ablation for Painful Skeletal Metastases
Patients with skeletal metastatic disease often have inadequate pain relief and conventional treatments, including external beam radiation therapy and opioid analgesics, often fail to provide pain relief and when relief is obtained, the duration is often
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Matthew Callstrom
Abstract
Patients with skeletal metastatic disease often have inadequate pain relief and conventional treatments, including external beam radiation therapy and opioid analgesics, often fail to provide pain relief and when relief is obtained, the duration is often short. Side effects of conventional therapies may also markedly decrease their quality of life, and few options are available for pain relief in patients with painful bone metastases who fail standard treatments. Image-guided percutaneous radiofrequency ablation of focal painful metastases has emerged as an effective focal treatment for patients with painful metastatic disease. This treatment offers clinically significant reduction of pain, an improvement in their quality of life and reduction in the use of analgesic medications by these patients.
Introduction Metastases involving bone are a common problem in cancer patients and are a frequent source of pain and morbidity [1, 2]. In fact, up to 85 % of patients that die from lung, breast, and prostate cancer have bone metastases at the time of death [1]. Patients often suffer reduced performance status and poor quality of life due to complications from skeletal metastases resulting from pain, fractures, and decreased mobility. In addition, these complications can affect a patient’s
M. Callstrom Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA e-mail: [email protected]
mood, leading to associated depression and anxiety [1]. Although bone metastases usually indicate a poor prognosis, with patients experiencing a median survival of 3 years or less, a significant fraction, 5–40 %, of patients are alive at 5 years dependent on tumor histology and burden [3, 4]. Treatments for patients with bone metastases are primarily palliative and include the following: systemic therapies (chemotherapy, hormonal therapy, radiopharmaceuticals, and bisphosphonates) and analgesics (opioids and nonsteroidal anti-inflammatory drugs) and localized therapies including surgery, radiation, and ablative therapies. The current standard of care for patients with localized bone pain due to metastatic disease is external beam radiation therapy (RT). A majority of patients experience complete or partial relief
D.E. Dupuy et al. (eds.), Image-Guided Cancer Therapy, DOI 10.1007/978-1-4419-0751-6_44, # Springer Science+Business Media New York 2013
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of pain following RT: however, it is typically several weeks before relief is achieved, and pain relief response is transient in more than 50 % of the patients that had an initial response to treatment. A prospective trial involving 1,016 patients conducted by the Radiation Therapy Oncology Group (RTOG) found RT resulted in complete relief in 53 % of patients with half of these patients achieving this relief in greater than 4 weeks [5]. Complete or partial relief was observed in a total of 83 % of the patients studied. The median duration of response for those patients that had partial pain relief was 20 weeks and 12 weeks for those
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