The distribution of heat in bone during radiofrequency ablation of an ex vivo bovine model of osteoid osteoma

Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges

Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.

Safe and Effective Treatment Choice for Osteoid Osteoma: Computed Tomography-guided Percutaneous Radiofrequency Ablation

Introduction

Osteoid osteoma (OO) is a painful, benign, bone-forming tumor characterized by a small central nidus surrounded by sclerotic tissue. The aim of the present study was to evaluate the clinical outcome after computed tomography (CT)-guided radiofrequency ablation (RFA) in patients with OO performed from January 2012 to June 2018 and to confirm the safety and efficacy of CT-guided RFA.

Methods

Between January 2012 and June 2018, a total of 63 patients were treated with CT-guided RFA. Pre- and post-treatment pain, further treatment after the RFA procedure, observed complications, and satisfaction with the treatment were recorded for an assessment of clinical effects in all patients. The patients were evaluated with the visual analog scale (VAS) pre-procedure and at three months post-procedure.

Results

Of the patients, 39 were males and 24 were females with a mean age of 21 ± 9.7 (range, 9 to 41) years. The mean follow-up was 16 ± 2.1 (range, 12 to 19) months. The mean duration of the procedure was 34 ± 11.4 (range, 22 to 47) min. All of the patients were diagnosed with OO pathologically. A statistically significant difference was found between the pre-procedural and post-procedural VAS scores (p<0.001). Complications were observed in six patients including one peroneal nerve lesion, three minor skin burns, and two minor skin infections.

Conclusion

This study shows that CT-guided RFA is a safe and effective treatment for OO. It is thought that RFA could be the primary treatment choice for most OO with typical symptoms and radiological findings.

Successful percutaneous treatment of osteoid osteoma in a 13 month-old boy with radiofrequency ablation under CT guidance

We present a 13-month-old boy who had a successful Computed Tomography (CT) guided percutaneous radiofrequency ablation (RFA) treatment for the osteoid osteoma (OO) on proximal part of the tibial diaphysis.

The complaints of the patient were being restless due to pain and refusing to bear any weight on his left leg for 6 months. An asymmetrical cortical thickening and a focal sclerosis was detected on medial proximal diaphysis of the left tibia on radiographs and axial T2-weighted STIR-MR image showed bone marrow and soft-tissue edema with low-signal-intensity nidus due to central calcification with a high-signal-intensified unmineralized periphery. CT findings (the nidus on the cortex of tibia with well circumscribed lucent region around a central sclerotic dot and cortical thickening around the nidus) confirmed the diagnosis of OO.

After CT guided percutaneous RFA treatment, the patient had an immediate pain relief in 24 h after and could bear weight on the leg. 12 and 16 months after RFA respectively, CT images and radiographs revealed sclerotic healing of the nidus and a slow regression of the adjacent cortical thickness without any recurrence.

Percutaneous radiofrequency ablation versus open surgical resection for spinal osteoid osteoma

BACKGROUND CONTEXT

Both open surgical resection (OSR) and radiofrequency ablation (RFA) have been reported for spinal osteoid osteoma (OO).

PURPOSE

To verify the clinical safety and efficiency of RFA with OSR in treating spinal OO.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

Twenty-eight consecutive patients with spinal OO who underwent either RFA or OSR in our institute between September 2006 and December 2016.

OUTCOME MEASURES

The age, gender, lesion distribution, surgical time, estimated blood loss, complications, local recurrence, visual analogue scale (VAS), and the modified Frankel grade were documented.

METHODS

We retrospectively reviewed 28 patients with spinal OO who had been treated in our hospital from September 2006 to December 2016. Patients were followed at 3, 6, 12, and 24 months after the index surgery. The minimum follow-up period was 12 months. This study was funded by Peking University Third Hospital (Y71508-01) (¥ 400,000).

RESULTS

Twelve and 16 patients were treated with CT-guided percutaneous RFA and OSR, respectively. Spinal OO locations were cervical in 4, thoracic in 4, lumbar in 3, and sacral vertebra in 1 in the RFA group and cervical in 12, thoracic in 1, and lumber in 3 in the OSR group. RFA showed shorter operating time, less blood loss, and less in-hospital stay than open surgery [105.0 ± 33.8 minutes vs. 186.4 ± 53.5 minutes (p < .001), 1 (0 to 5) ml vs. 125 (30-1200) ml (p < .001) and 1 (1-3) days vs. 6 (3-10) days (p < .001), respectively]. At last follow-up, one patient underwent a secondary RFA for recurrence. VAS improvement was 7.5 (3-10) and 6.5 (4-9) (p = .945) in the RFA and OSR groups, respectively. The overall complication rate was 8.3% (1/12) and 18.8% (3/16) in the RFA and OSR groups, respectively.

CONCLUSIONS

If there is sufficient cerebrospinal fluid between the spinal OO lesion and spinal cord/nerve root (more than 1 mm), RFA is effective and safe for treatment of well-selected spinal OO, showing reduced operating time, blood loss, in-hospital stay, and complications compared to OSR. However, OSR is still recommended in cases with spinal cord/nerve root compression.

Radiofrequency ablation of osteoid osteoma: Aiming for excellent outcomes in an Australasian context

INTRODUCTION

To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred.

METHODS

Over a 13-year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre.

RESULTS

All patients had resolution of symptoms with no complication or recurrence.

CONCLUSIONS

This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma.

Osteoid osteoma of the acetabulum: diagnosis and medical treatment

We describe the medical management of an acetabular osteoid osteoma in an 11-year-old girl. There was a 2-year delay until proper diagnosis of the patient's pathology was made. Accurate localization of the nidus in the subchondral bone, involving the cartilage, is difficult on the basis of plain radiographs. All imaging methods, including computed tomography, MRI, and bone scintigraphy, were used to confirm the diagnosis. We proposed medical treatment to avoid possible severe complications from surgical intervention. At the patient's latest follow-up visit, after 2 years of medical treatment with NSAIDs, there is complete healing of the osteoid osteoma and there is no sign of recurrence.