Department of Diagnostic Imaging, the Warren Alpert Medical School at Brown University, Providence, RI 02903, USA.
Cancer. 2010 Feb 15;116(4):989-97. doi: 10.1002/cncr.24837.
The study was conducted to determine whether radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease.
The single-arm prospective trial included patients with a single painful bone metastasis with unremitting pain with a score >50 on a pain scale of 0-100. Percutaneous computed tomography-guided RFA of the bone metastasis to temperatures >60 degrees C was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, 1 month, and 3 months after RFA.
Fifty-five patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%) patients. RFA reduced pain at 1 and 3 months for all pain assessment measures. The average increase in pain relief from pre-RFA to 1-month follow-up is 26.3 (95% confidence interval [CI], 17.7-34.9; P < .0001), and the increase from pre-RFA to 3-month follow-up is 16.38 (95% CI, 3.4-29.4; P = .02). The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9 (P < .0001) and 14.2 for 3-month follow-up (P = .02). The odds of lower pain severity at 1-month follow-up were 14.0 (95% CI, 2.3-25.7; P < .0001) times higher than at pre-RFA, and the odds at 3-month follow-up were 8.0 (95% CI, 0.9-15.2; P < .001) times higher than at pre-RFA. The average increase in mood from pre-RFA to 1-month follow-up was 19.9 (P < .0001) and 14.9 to 3-month follow-up (P = .005).
This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases.
本研究旨在确定射频消融（RFA）是否能安全减轻骨转移瘤所致疼痛。
这项单臂前瞻性试验纳入了因单个骨转移瘤疼痛且疼痛评分＞50（疼痛评分 0-100）分而持续存在疼痛的患者。对骨转移瘤行经皮 CT 引导下 RFA，使温度＞60℃。终点为 RFA 前及 RFA 后 2 周、1 个月和 3 个月的毒性和疼痛效应。
55 例患者完成了 RFA。3 例（5%）患者出现 3 级毒性。所有疼痛评估指标在 1 个月和 3 个月时均显示 RFA 减轻了疼痛。RFA 后从术前到 1 个月随访时疼痛缓解的平均增加量为 26.3（95%置信区间 [CI]，17.7-34.9；P＜0.0001），从术前到 3 个月随访时的增加量为 16.38（95% CI，3.4-29.4；P=0.02）。RFA 后从术前到 1 个月随访时疼痛强度的平均降低量为 26.9（P＜0.0001），3 个月随访时为 14.2（P=0.02）。1 个月随访时疼痛严重程度降低的几率比术前高 14.0 倍（95% CI，2.3-25.7；P＜0.0001），3 个月随访时降低的几率比术前高 8.0 倍（95% CI，0.9-15.2；P＜0.001）。RFA 后从术前到 1 个月随访时情绪的平均增加量为 19.9（P＜0.0001），从术前到 3 个月随访时为 14.9（P=0.005）。
这项合作组试验强烈表明，RFA 能安全减轻骨转移瘤所致疼痛。
