Carrafiello G, Laganà D, Pellegrino C, Fontana F, Mangini M, Nicotera P, Petullà M, Bracchi E, Genovese E, Cuffari S, Fugazzola C
Cattedra di Radiologia, Ospedale di Circolo di Varese, Università degli Studi dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
Radiol Med. 2009 Jun;114(4):608-25. doi: 10.1007/s11547-009-0395-5. Epub 2009 May 14.
The treatment of pain in bone metastases is currently multidisciplinary. Among the various therapies, local radiotherapy is the gold standard for pain palliation from single metastasis, even though the maximum benefit is obtained between 12 and 20 weeks from initiation. In carefully selected patients, several ablation therapies achieve this objective in 4 weeks. The purpose of this study was to assess the technical success, effectiveness and possible complications of percutaneous ablation therapies in patients with symptomatic bone metastases.
From November 2003 to May 2008, ten ablation treatments were performed in ten patients with acute pain from metastatic bone lesions. Patient selection and choice of the most appropriate ablation treatment was made based on lesion characteristics. Three patients were treated with radiofrequency, one with plasma-mediated radiofrequency, two with plasma-mediated radiofrequency and cementoplasty, three with radiofrequency and cementoplasty and one with microwave.
Assessments were based not only on imaging but also on the visual analogue scale (VAS) score for determining pain and on changes in morphine-equivalent doses. In both cases, 3-month follow-up showed a statistically significant reduction of pain. In no case did local complications occur either during or after treatment. Only one patient treated with radiofrequency (1/9, 11%) developed low-grade fever and general malaise during the 6 days following the procedure, compatible with a post-radiofrequency syndrome, which was treated with acetaminophen (paracetamol) only and resolved on day 7.
Percutaneous ablation therapies represent a safe and valuable alternative for treating localised pain from single bone metastasis, providing rapid (4-week) relief of symptoms and a significant reduction in morphine doses. This contributes to improving the quality of life of patients with metastatic disease.
目前骨转移瘤疼痛的治疗是多学科的。在各种治疗方法中，局部放疗是单一转移瘤疼痛缓解的金标准，尽管从开始治疗到12至20周时能获得最大益处。在经过精心挑选的患者中，几种消融治疗在4周内即可达到这一目标。本研究的目的是评估经皮消融治疗有症状骨转移瘤患者的技术成功率、有效性及可能的并发症。
2003年11月至2008年5月，对10例因转移性骨病变导致急性疼痛的患者进行了10次消融治疗。根据病变特征进行患者选择并选择最合适的消融治疗方法。3例患者接受射频治疗，1例接受等离子介导射频治疗，2例接受等离子介导射频和骨水泥成形术，3例接受射频和骨水泥成形术，1例接受微波治疗。
评估不仅基于影像学，还基于视觉模拟量表（VAS）评分来确定疼痛情况以及吗啡等效剂量的变化。在这两种情况下，3个月的随访显示疼痛有统计学意义的减轻。治疗期间及治疗后均未发生局部并发症。仅1例接受射频治疗的患者（1/9，11%）在术后6天出现低热和全身不适，符合射频后综合征，仅用对乙酰氨基酚（扑热息痛）治疗，于第7天缓解。
经皮消融治疗是治疗单发性骨转移瘤局部疼痛的一种安全且有价值的替代方法，能快速（4周）缓解症状并显著减少吗啡剂量。这有助于改善转移性疾病患者的生活质量。
