Percutaneous treatment of bone tumors by radiofrequency thermal ablation

Heat treatment for giant cell tumors of bone: A systematic review

This systematic review evaluates the effects of heat treatments in de novo, residual and recurrent giant cell tumors of bone (GCTB). Studies were eligible for inclusion if one of the following treatments was administered: radiofrequency ablation (RFA), microwave ablation, argon cauterization, electrocauterization and hot liquid treatment. The primary outcome was recurrence. Secondary outcomes were complications, pain, function, and quality of life. Recurrence rates for microwave ablation as an adjuvant to intralesional curettage were 0%, 4% and 10% (3 retrospective single-group studies); for argon cauterization 4%, 8% and 26% (3 cohort studies); electrocauterization 0% to 33% (8 cohort studies); and hot liquid 9.5% and 24% (2 cohort studies). Follow-up was generally ≥24 months. Data on pain, function and quality of life were scarce. Complications included infection and secondary osteoarthritis. Current evidence does not demonstrate or exclude an effect of heat treatments on recurrence in GCTB. Further research should objectify if (subgroups of) patients benefit from these treatments.

Radio Frequency Ablation for the Treatment of Appendicular Skeleton Chondroblastoma: Is It an Excellent Alternative? Systematic Review and Meta-Analysis

Radio frequency ablation (RFA) is a minimally invasive technique that has become recognized in clinical practice for treating chondroblastoma, although curettage with bone graft is the standard treatment. Chondroblastoma is a locally aggressive cartilaginous bone tumor, representing nearly 5% of benign bone tumors. Chondroblastoma shows a preference toward the epiphysis or apophysis of long bones, but it was also reported in vertebrae and flat bones. The management of chondroblastoma could be challenging due to the risk to injure the epiphyseal plate or difficult location. The aim of this study was to determine if RFA is a suitable alternative to curettage with bone graft for the treatment of chondroblastoma. Moreover, there will be an evaluation of RFA's effectiveness in terms of symptoms relief; we also define the proper size of the lesion to be treated with RFA, and discuss the complications after the procedure, including the recurrence rate. Furthermore, we review the best imaging method to evaluate the therapeutic response of RFA and for the detection of residual disease early after the ablation. A comprehensive PubMed and Google Scholar search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 checklist guidelines. Ninety-seven patients were identified after reviewing the available full texts of nine articles. The results of the current review provide further evidence to support the use of RFA as an alternative option to surgery.

Treatment alternatives and clinical outcomes of bone filling after benign tumour curettage. A systematic review

BACKGROUND

Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling?

PATIENTS AND METHODS

The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest.

RESULTS

The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96.

CONCLUSION

Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity.

LEVEL OF EVIDENCE

III; systematic review.

Percutaneous CT-guided radiofrequency ablation of osteoid osteoma: Potential Pitfalls and complications and how to avoid them

Targeted cannulation of the nidus and subsequent thermal ablation is the basis of CT-guided radiofrequency ablation (RFA) of osteoid osteoma, which is considered nowadays as the treatment of choice. The majority of complications during this procedure are due to thermal injury of adjacent structures. Specific measures as per the anatomical location of osteoid osteoma can avoid the majority of complications. This article enlists the possible complications and their necessary precautions and remedies to avoid these complications during CT-guided radiofrequency ablation of osteoid osteoma.

Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation

PURPOSE

To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma.

MATERIALS AND METHODS

This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm). According to tumour size and location, monopolar electrode's active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases. Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale.

RESULTS

Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse. In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed.

CONCLUSION

Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.

Percutaneous bipolar radiofrequency ablation for spine metastatic lesions

PURPOSE

The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.

METHODS

We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information.

RESULTS

RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine.

CONCLUSION

Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.

Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

Image-guided radiofrequency ablation (RFA) has been accepted as a minimally invasive treatment for adrenal tumors in patients who are unable to undergo adrenalectomy. Accordingly, this treatment has become more readily available for treating functioning or non-functioning adrenal masses. Thus, endocrinologists need a better understanding of percutaneous RFA of adrenal tumors. The purpose of this review is to briefly describe the basic mechanism of RFA, indications and contraindications, patient preparation prior to RFA, type of complications, how to avoid complications, RFA procedures, and treatment outcomes.

Percutaneous thermal ablation for treatment of osteoid osteoma: a systematic review and analysis

OBJECTIVE

Although radiofrequency ablation is well validated for treatment of osteoid osteoma, newer technologies, namely cryoablation, have been less thoroughly studied. The purpose is to perform a systematic review and pooled analysis of percutaneous ablation technologies for treatment of osteoid osteoma with subset analysis of intra-articular and spinal tumors.

MATERIAL AND METHODS

A total of 36 of 79 identified manuscripts met inclusion criteria, comprising 1863 ablations in 1798 patients. Inclusion criteria were (1) retrospective or prospective analysis of thermal ablation of osteoid osteomas in any location, (2) at least 6 months of clinical follow-up, (3) 10 or more patients, (4) patients not included in a second study included in this review, and (5) English language or English translation available. Success rate was defined as all ablations minus technical failures, clinical failures, and recurrences. Subset analysis of intra-articular and spinal tumors was performed.

RESULTS

Overall success rate was 91.9% (95% CI 91-93%). Technical failure, clinical failure, and recurrence rates were 0.3%, 2.1%, and 5.6% respectively. Complications were seen in 2.5% (95% CI 1.9-3.3%) patients. There was no significant difference when comparing radiofrequency ablation and cryoablation (p = 0.92). Success rates for intra-articular (radiofrequency ablation) and spinal tumors (radiofrequency and cryoablation) were 97% and 91.6% respectively.

CONCLUSION

Percutaneous ablation of osteoid osteomas was highly successful with low complication rates. Efficacy of radiofrequency ablation and cryoablation is similar, which is consequential because cryoablation is associated with decreased pain, predictable nerve regeneration, and theoretical immunotherapy benefits. Treatment of more challenging intra-articular and spinal lesions demonstrated similarly high success and low complication rates.

CT fluoroscopy-guided percutaneous osteoplasty with or without radiofrequency ablation in the treatment of painful extraspinal and spinal bone metastases: technical outcome and complications in 29 patients

PURPOSE

We aimed to assess the safety and technical outcome of computed tomography (CT) fluoroscopy-guided osteoplasty with or without prior percutaneous radiofrequency ablation (RFA) in patients with painful osteolyses.

METHODS

We performed a retrospective analysis of 29 patients with painful extraspinal and spinal osteolyses (16 women, 13 men; 63.1±14.4 years) who underwent CT fluoroscopy-guided osteoplasty (10-20 mAs tube current) with or without RFA (26 and 14 lesions, respectively), in 33 consecutive procedures from 2002 to 2016. Technical success was defined as at least one complete RFA cycle and subsequent polymethyl metacrylate (PMMA) bone cement injection covering ≥75% of longest diameter of extraspinal osteolysis on axial plane or of distance between vertebral endplates. Procedure-related complications within 30 days and dose-length-product (DLP) were also evaluated.

RESULTS

Osteolyses were located in the pelvis (acetabulum, n=10; iliac bone, n=4), spine (thoracic, n=6; lumbar, n=5; sacral, n=8), long bones (femur, n=3; tibia, n=1), sternum (n=2) and glenoid (n=1). Mean size of the treated osteolysis was 4.0±1.2 cm (range, 1.9-6.9 cm). Of 40 osteolyses, 31 (77.5%) abutted neighboring risk structures (spinal canal or neuroforamen, n=18; neighboring joint, n=11; other, n=8). Mean number of RFA electrode positions and complete ablation cycles was 1.5±0.9 and 2.1±1.7, respectively. Mean PMMA filling volume was 7.7±5.7 mL (range, 2-30 mL). Small asymptomatic PMMA leakages were observed in 15 lesions (37.5%). Mean total DLP was 850±653 mGy*cm. Six minor complications were observed, without any major complications.

CONCLUSION

CT fluoroscopy-guided percutaneous osteoplasty with or without concomitant RFA for the treatment of painful extraspinal and spinal osteolyses can be performed with a low complication rate and high technical success.

Radiofrequency ablation of osteoid osteoma in the atlas: A case report

Osteoid osteoma of the atlas has previously been reported very rarely in the published literature. The traditional standard treatment has been a surgical resection of the nidus. Recently, computed tomography (CT)-guided radiofrequency ablation (RFA) has gained favor as a more precise alternative treatment. Here, we present a case of osteoid osteoma of the C1 lateral mass treated successfully using CT-guided RFA. A 30-year-old woman who presented with a four-month history of occipital and suboccipital pain was treated by CT-guided RFA. The visual analog scale (VAS) assessed the pain before and after RFA. The patient reported significant pain relief and normal activities. The VAS score reduced from 8/7 to 1/0 after the procedure. Therefore CT-guided percutaneous RFA of C1 vertebral osteoid osteoma is a safe and effective method. The technique might be contraindicated when the nidus is less than 2 mm away from the neural structures.

Evaluation of minimally invasive laser ablation in children with osteoid osteoma

The effects between minimally invasive percutaneous laser ablation and open surgery in the treatment of children with osteoid osteoma were compared in the present study. A total of 72 cases of children with osteoid osteoma were divided into control and observational groups, containing 36 cases in each group. The control group underwent conventional open surgery while the observational group underwent minimally invasive CT guided percutaneous laser ablation. Effects of both operations were compared. The operation duration, blood loss and plaster fixation duration of the observational group were significantly less than those of the control group. The postoperative pain score (VAS) at 1 day and 7 days were significantly lower than that of the control group, the differences were statistically significant (P<0.05). The lesion resection rate, effective rate of bone hyperplasia, effective rate of swelling and effusion and total effective rate of the observational group were significantly higher than those of the control group, the differences were statistically significant (P<0.05). Incidence of adverse reactions of observational group was significantly lower (P<0.05) than that of the control group. However, the difference was not significant when comparing 1-year recurrence rate for the two groups. The minimally invasive percutaneous laser ablation has better surgery effects compared with open surgery in the treatment of children with osteoid osteoma.

Treatment of focal benign lesions of the bone: MRgFUS and RFA

The objective of this study was to evaluate the role of MR-guided focused ultrasound surgery and radiofrequency ablation in the management of bone and soft-tissue lesions. Musculoskeletal interventional radiology represents an interesting option for the treatment of benign bone and soft-tissue lesions to avoid the invasiveness of surgery and related risks. The imaging techniques now available, besides representing an optimal guide, allow control of the temperature reached in the region of interest, avoiding or minimizing damage to the sensitive structures surrounding the lesion.

Removal of osteoblastoma of the talar neck using standard anterior ankle Arthroscopy：A case report

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We present the first, to our knowledge, case of osteoblastoma of the talar that was excised using standard anterior ankle arthroscopy.

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Osteoblastoma of the talar is rare.

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We present the first case, to our knowledge, that was excised using standard anterior ankle arthroscopy.

Introduction

Osteoblastoma of the talus, a benign tumor, is rare in orthopedics. The choice of treatment is usually open surgery for excision of tumor. Limited data is available concerning arthroscopic approaches.

Presentation of case

A 36-year-old male patient was evaluated for pain and swelling of the left ankle joint. Based on the findings of physical examination, X-rays and MRI investigations, the tumor was isolated. Standard anterior arthroscopic surgery was performed due to ankle pain. A diagnosis of osteoblastoma of the talar neck was made following the pathological survey. He had no recurrent pain and normal joint mobility 5 years postoperatively during he was regularly followed up.

Discussion

Osteoblastoma of the talar neck is slowly progressive and it is a palpable painful mass. Open or arthroscopic surgery can be performed. Treatment strategies are decided on according to the tumor's location, extent and size. Some advantages of arthroscopic surgery are wide visualization areas, minimally invasion, low morbidity, no necessity for casting and immobilization, early rehabilitation and quick recovery.

Conclusion

In conclusion, arthroscopic management can be successful in selected patients with small benign tumor localized to the ankle joint.

Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques

Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both.

Treatment of osteoid osteoma of the elbow by radiofrequency thermal ablation

BACKGROUND

This article presents the experience at the Rizzoli Orthopaedic Institute in the treatment of intracapsular osteoid osteoma (OO) of the elbow by computed tomography-guided percutaneous radiofrequency thermal ablation (RFA).

MATERIALS AND METHODS

Our team performed more than 800 RFA procedures to treat OO up to 2010. In 27 cases, the lesion site was the articular area of the elbow (humerus in 13 cases, ulna in 13, and radius in 1). These patients were reviewed and assessed for eradication rate, incidence of complications, and functional results measured by the Mayo Elbow Performance Score. The outcome was evaluated after a mean follow-up period of 67.4 ± 35.3 months (range, 24-128 months).

RESULTS

The mean duration of symptoms at the time of diagnosis was 31.0 ± 19.8 months (range, 5-72 months). All patients complained about pain, and in 24 of 27 cases (88.8%), the joint function was significantly impaired by the presence of OO (pretreatment score, 54.8). After RFA, the Mayo Elbow Performance Score improved by a mean of 37.7 ± 14.8 points, with 25 of 27 patients (92.5%) scoring 90 to 100 points at final follow-up. OO recurred in only 1 patient (3.7%), 5 months after the procedure. However, this was successfully retreated by RFA. No adverse effects were observed, and all patients were free of disease at the final follow-up.

DISCUSSION

The RFA procedure can be technically challenging in difficult sites such as the elbow joint. The low invasiveness of RFA compared with traditional surgery allows excellent functional recovery. RFA of elbow OO is effective and safe, and it should be considered the first-choice treatment for this disease.

[Tumors of the foot: diagnostics and therapy]

Despite the compact anatomy with thin soft tissue coverage, diagnosis of both benign and malignant tumors of the foot is often delayed. Diagnostic errors are more common than in other body regions, as neoplasias are rarely considered. Barring a few exceptions the foot is not a typical predilection site for malignant musculoskeletal tumors, although, basically any tumor entity of the musculoskeletal system can affect the foot. Delays in specific diagnostic and therapeutic procedures of these lesions can entail serious consequences for patients as tumor size is a major prognostic factor for recurrence-free survival. In cases of an indistinct persistent swelling or bone lesion a tumorous process should always be considered to ensure early diagnosis and therapy of foot tumors.

Resection of osteoid osteoma of distal tibia using the intraoperative isotopic scan

Osteoid osteomas are small-sized benign painful bony tumors. The authors report the case of an osteoid osteoma located in the distal third of the tibia, treated by the surgical excision of the nidus using the intraoperatively isotopic marking which allows reducing the incision size and the bony resection.

Excessive gastrocnemius fibrosis developed after radiofrequency-induced cosmetic volume reduction

Cosmetic shaping of the lower leg is becoming increasingly popular. The use of radiofrequency therapy in cosmetic medicine also is growing. To date, no serious complications have been reported after the use of cosmetic radiofrequency therapy. This report describes a patient who presented at the author's clinic with a disabling ankle plantarflexion contracture in both calves that developed during a period of 18 months after cosmetic radiofrequency volume reduction. This reduction, performed at another clinic, involved applying a bipolar electrode with a mean power of 35 W at each of approximately 100 spots for 2 to 4 s. On each calf, 15 kJ was applied in a crisscross fashion. Magnetic resonance imaging and muscle biopsy indicated excessive gastrocnemius fibrosis. The patient was treated using botulinum toxin injections followed by serial castings and intensive physiotherapy. After treatment, the patient was able to walk with less difficulty and showed no tiptoeing. This appears to be the first report of serious muscle contracture after cosmetic radiofrequency volume reduction requiring extensive rehabilitation management.

The clinical evaluation of bone tumors

Bone tumors are uncommon clinical entities that are often a source of diagnostic and therapeutic uncertainty. Evaluating these lesions starts with a patient history and physical examination Imaging then begins with radiographs, followed by advanced imaging modalities, such as magnetic resonance imaging, computed tomography, or bone scan. Biopsy can be performed to establish histologic diagnosis by either closed or open means. Treatment options range from observation to wide resection with reconstruction or amputation. Surveillance schedules vary depending on the type of tumor that is being treated. An algorithm for the evaluation, work-up, and diagnosis of bone tumors is presented.