Deschamps F, Farouil G, de Baere T
Department of Interventional Radiology, Gustave-Roussy Institute, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
Department of Interventional Radiology, Gustave-Roussy Institute, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
Diagn Interv Imaging. 2014 Jul-Aug;95(7-8):659-63. doi: 10.1016/j.diii.2014.04.004. Epub 2014 Jul 10.
Percutaneous ablation (radiofrequency or cryotherapy) of bone tumors is most often performed for palliative purposes. Many studies have shown that percutaneous ablation of a painful bone metastasis can significantly and sustainably reduce symptoms. It is therefore an alternative to radiotherapy and to long-term opiates. Percutaneous ablation can also be performed for curative purposes. In this situation, its efficacy has however only been studied to a very small extent (apart from radiofrequency ablation of osteoid osteomas in which the success rate is almost 100%). In our experience, the success rate after radiofrequency ablation of a bone metastasis is 75% if it is less than 3cm in diameter and fall significantly over this (to 40%, P=0.04). This treatment can therefore be justified in oligometastatic patients whose disease is progressing slowly. Its benefit on survival has however not been assessed in this selected population. Whether it is performed for palliative or curative reasons, percutaneous ablation should ideally be followed by an injection of cement if the metastasis being treated is lytic and located in a bone, which is subject to mechanical forces. The aim of consolidating cementoplasty is to counterbalance the additional risk of fracture due to destruction of the percutaneously ablated bone.
经皮消融（射频或冷冻治疗）骨肿瘤通常用于姑息治疗目的。许多研究表明，经皮消融疼痛性骨转移瘤可显著且持续地减轻症状。因此，它是放疗和长期使用阿片类药物的替代方法。经皮消融也可用于根治性目的。然而，在这种情况下，其疗效仅在很小程度上得到研究（除了骨样骨瘤的射频消融，其成功率几乎为100%）。根据我们的经验，如果骨转移瘤直径小于3cm，射频消融后的成功率为75%，而直径超过此值时成功率显著下降（降至40%，P=0.04）。因此，对于疾病进展缓慢的寡转移患者，这种治疗是合理的。然而，在这一特定人群中尚未评估其对生存的益处。无论出于姑息还是根治目的进行经皮消融，如果所治疗的转移瘤为溶骨性且位于承受机械力的骨中，理想情况下应在消融后注射骨水泥。骨水泥强化成形术的目的是抵消经皮消融骨破坏导致的骨折额外风险。
