Minimally invasive techniques for pain palliation in extraspinal bone metastases: a review of cementoplasty and radiofrequency ablation

Abstract

Minimally invasive techniques are an effective primary or alternative modality for pain palliation in extraspinal bone metastases, particularly when conventional therapies such as localized radiation therapy leave a subset of patients with refractory pain. Cementoplasty is hypothesized to work through the stabilization of microfractures and has been most commonly performed in osteolytic lesions of the femur and acetabulum. Specific indications and contraindications are highlighted for both locations. Radiofrequency ablation is hypothesized to reduce pain through tumor reduction and periosteal nerve destruction and has been studied most extensively in the pelvis and chest wall. Radiofrequency ablation combined with localized radiation therapy has shown promising improvement in pain relief compared to radiation therapy alone, and combination cementoplasty and radiofrequency ablation may have specific benefit in the acetabulum. Both cementoplasty and radiofrequency ablation have been shown to work as soon as within 24 hours and for as long as 6 months. Future prospective, randomized trials are needed to compare the efficacy of these treatments.