Quality Improvement Guidelines for Bone Tumour Management

Abstract

Curative treatment The therapeutic goal of curative treatment is to completely and definitively ablate the tumour. Palliative treatment The therapeutic goal of palliative treatment is not to completely ablate the tumour but to achieve pain palliation. Consolidation Techniques Cementoplasty Percutaneous injection of methylmethacrylate provides bone strengthening and pain relief [5, 6]. Cementoplasty is a symptomatic and not a curative treatment [7, 8]. Ablation Techniques Chemical ablation Injection of ethanol is used to ablate osteolytic bone tumours as well as achieve pain management (neurolysis) [9]. Thermal ablation procedures consist of the following: 1. Laser photocoagulation Thermoablation is produced with near-infrared wavelength lasers (neodymium yttrium aluminum garnet [Nd:YAG] diode laser 800–1000 nm). 2. Radiofrequency ablation Thermoablation is produced by altering the electric current at the tip of the electrode, thus causing local ionic agitation and subsequent frictional heat. 3. Cryoablation The application of extreme cold aims to destroy cells by causing both direct cellular and vascular injury [10, 11]. Radiofrequency ionisation (decompression ablation technique) consists of the following: 1. Low-temperature bipolar technique: This produces a plasma field at the tip of the electrode that breaks the intermolecular bonds, thus creating a cavity inside the tissue, which leads in turn to decompression.