Radiofrequency ablation (RFA) with CT guidance.
January 5, 2010 – Each year in United States, more than a million new cancer cases are diagnosed. Between 30 and 70 percent of these patients will develop a bone metastasis ? an often intensely painful condition, and current pain treatments are not effective for all of these patients.
In a recent study, doctors used image-guided radiofrequency ablation (RFA), a minimally invasive cancer treatment using heat to ablate tumor cells, to significantly reduce the level of pain experienced by cancer patients with bone (osseous) metastases, limiting the need for strong narcotic pain management, and supporting improved patient frame of mind, according to results of an American College of Radiology Imaging Network (ACRIN) study published online Jan. 4, 2010, in the journal Cancer.
This study, sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), demonstrated that RFA, often used to treat liver, kidney and lung cancer tumors, is also a safe and effective pain management tool for patients with bone metastases.
"RFA is widely available, covered by most insurance, can be performed in a single outpatient session and often allows patients enhanced interaction with loved ones by reducing use of strong narcotics which can leave them in a medicated state. Also, unlike many other cancer pain management treatments, RFA can be repeated and maintain similar results,” said Damian Dupuy, M.D., principal investigator of the study, director of ablation services at Rhode Island Hospital, and professor of diagnostic imaging at The Warren Alpert Medical School of Brown University.
The researchers studied 55 patients who had a single painful bone metastasis. Each received computed tomography (CT) guided RFA of the tumor. Patients evaluated their pain prior to treatment, then daily for two weeks following the procedure, and again at one month and three months after RFA. The study results showed statistically significant pain reduction at the one and three-month follow-ups for all pain assessment measurements: pain relief, intensity and severity. In all cases, improvement was seen for each measurement, including patient mood, with the most improvement at the one-month interval.
“We know that RFA is a highly effective cancer treatment when surgery is not an option. RFA offers potential advantages over other methods in that cell death is immediate, lesion size can be accurately controlled, lesion temperature can be monitored, and it can be performed under local anesthesia and conscious sedation in the outpatient setting. This is a significant step forward in the pain management of these patients,” said Dr. Dupuy.
The procedure was found to be safe with few adverse events. RFA can be an alternative for patients who previously received radiation therapy and have reached their maximum radiation dose, but are still experiencing pain.
The study demonstrates the palliative benefits of RFA with minimal treatment-related morbidity, noted Thomas DiPetrillo, clinical director of radiation oncology at Rhode Island Hospital and associate professor of radiation oncology at The Warren Alpert Medical School of Brown University.
For more information: www.acr-arrs.org