Percutaneous Bone Metastasis Ablation

Background and indications

Percutaneous bone metastasis ablation (radiofrequency, microwave, or cryoablation) is a palliative or curative treatment for bone tumor lesions. The main objective is pain control in painful bone metastases resistant to radiation and analgesics, or local tumor control in oligometastatic lesions. Cementoplasty (cement injection) may be combined to consolidate weakened bone.

Pre-procedure assessment

Assessment includes lesion MRI and/or CT, PET-CT (staging), coagulation panel, and tumor board discussion. Pain (VAS) and functional assessment are documented. Fracture risk is evaluated (Mirels score for long bones).

Procedure

Under general anesthesia and CT guidance, one or more ablation needles are inserted into the metastasis. Cryoablation is often preferred as it allows precise ice ball and margin visualization, particularly useful near nerve roots. RFA or MWA may be used for well-defined lesions. If needed, cementoplasty is performed simultaneously to consolidate bone. The procedure takes 1 to 3 hours.

Results and scientific evidence

Painful bone metastasis ablation offers significant pain relief in 80-90% of cases, with mean VAS decrease of 4-5 points (Dupuy et al., Cancer, 2010; DOI: 10.1002/cncr.24837). Combined ablation + cementoplasty enhances mechanical stability and pain control. Relief duration is 6-12 months in most cases.

Risks and complications

Post-procedural local pain (30-50%, transient), pathological fracture (2-5%, reduced by cementoplasty), nerve injury (< 2%, mainly for vertebral lesions). Complication risk varies by location.

Recovery

1-2 night hospitalization. Pain improvement within 24-72 hours. Progressive mobility recovery. Follow-up at 1 and 3 months.

Practical information

The procedure is performed as a short inpatient stay or outpatient depending on the case. It is performed by an interventional oncology radiologist, in coordination with the oncologist and radiation therapist.