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Quick
Summary
BOTTOM
LINE
This
cooperative
group
trial
strongly
suggests
that
RFA
can
safely
palliate
pain
from
bone
metastases.
MAJOR
POINTS
RFA
had
a
statistically
signi>icant
effect
in
reducing
pain
at
both
1-month
and
3-month
follow-up
for
all
four
pain
assessment
measures
(pain
relief,
patient
mood,
pain
intensity
and
pain
severity).
Previous
radiotherapy
to
the
site
did
not
statistically
correlate
with
reduction
in
pain
intensity,
mood
improvement
and
increase
in
pain
relief.
CRITICISM
Of
the
55
patients
who
completed
RFA,
13
(23.6%)
did
not
have
1-month
follow
up
and
23
(41.8%)
did
not
have
3-month
follow-up.
This
study
had
high"
attrition
rates
which
signi>icantly
affects
the
external
validity
of
this
study.
However,
the
clinical
improvement
with
inferential
data
is
robust
enough
to
recommend
this
option
as
a
palliative
measure
for
patients
who
have
exhausted
contemporary
measures
of
pain
management.
Study
design
SINGLE-ARM
PROSPECTIVE
TRIAL/
NCI-SPONSORED
CLINICAL
TRIALS
COOPERATIVE
PHASE
II
GROUP
STUDY
INCLUSION CRITERIA
EXCLUSION
CRITERIA
Purpose
The
purpose
of
this
study
is
to
determine
if
radiofrequency
ablation
can
safely
and
effectively
reduce
pain
from
osseous
metastatic
lesions.
Patients
often
have
persistent
unremitting
pain
despite
radiation
and
chemotherapy.
Interven7on
RFA
was
performed
using
Radionics
CC-1
(Valley
Lab,
Boulder,
CO)
generator
and
single
17-gauge
or
cluster
Cool-tip
electrode.
CT
was
used
to
localize
the
metastasis.
A
14-gauge
coaxial
bone
biopsy
needle
was
placed
into
the
lesion
if
cortical
bone
was
intact.
After
the
core
was
removed,
the
RF
electrode
was
placed
through
the
outer
cannula
into
the
lesion.
If
bone
cortex
was
destroyed
by
the
tumor,
the
RF
electrode
was
placed
directly
into
the
metastasis.
Tumors
>4
cm
were
treated
with
a
cluster
RF
electrode
(three
17-gauge
needles
spaced
5mm
apart).
Tumors
<4
cm
were
treated
with
single
electrodes
with
1-,
2-,
or
3-cm
active
tips.
The
initial
ablation
was
performed
for
a
maximum
of
4
minutes
using
a
current
of
1100-2000mA
(maximum
current
given
impedence
of
system).
A
target
intratumoral
temperature
greater
than
60
C
was
required
to
ensure
adequate
thermocoagulation.
If
the
temperature
exceeded
60
C,
the
electrode
was
withdrawn
in
1-cm
increments
up
to
the
length
of
the
active
tip
while
measuring
the
intratumoral
temperature.
If
the
intratumoral
temperature
dropped
below
60
C,
then
another
4-
minute
treatment
was
performed
at
the
new
position.
This
could
be
repeated
at
any
given
electrode
position
for
a
maximum
of
12
minutes
(3
treatments).
Once
the
entire
longitudinal
dimension
of
the
tumor
was
treated
with
a
series
of
overlapping
treatments,
then
the
RF
electrode
shaft
was
repositioned
1.5-2
cm
away
from
the
longitudinal
axis
of
the
prior
treatment
series.
This
was
repeated
until
the
cylinder-shaped
treatment
regions
encompassed
the
entire
volume
of
the
mass.
Vital
signs
were
monitored
for
a
minimum
of
2
hours
post-RFA.
Outcome
Pain
scores
by
timepoint
Mood
scores
by
timepoint
Relief
scores
by
timepoint
Pain
description
scores
by
timepoint
Credits
SUMMARY
BY:
David
Maldow,
MD,
PGY-1
FULL
CITATION:
Dupuy
DE,
Liu
D,
Hartfeil
D,
Hanna
L,
Blume
J,
Ahrar
K,
Lopez
R,
Safran
H
and
DiPetrillo
T.
Percutaneous
Radiofrequency
Ablation
of
Painful
Osseous
Metastases:
A
Multi-center
American
College
of
Radiology
Imaging
Network
Trial.
Cancer.
2010;116(4):
989-997.
sirweb.org