Specialization School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.
Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.
Skeletal Radiol. 2019 Aug;48(8):1161-1169. doi: 10.1007/s00256-018-3140-0. Epub 2019 Jan 9.
To review the efficacy of percutaneous thermal ablation (TA) of bone metastases (radiofrequency ablation [RFA], microwave ablation [MWA], cryoablation [CA], and MR-guided focused ultrasound [MRgFUS]) in reducing pain in patients with advanced stage cancer.
We searched MEDLINE/PubMed, MEDLINE In-Process, BIDS ISI, Embase, CINAHL, and the Cochrane database using the keywords "ablation," "painful," "bone," and "metastases" combined in multiple algorithms. Inclusion criteria were: original clinical studies published between 2001 and 2018; performance of RFA, MWA, CA or MRgFUS; and quantitative pain assessment before/after TA of bone metastasis.
Eleven papers (3 on RFA, 1 on MWA, 2 on CA, and 5 on MRgFUS) involving 364 patients were reviewed. A technical success rate of 96-100% was reported, with follow-up for up to 6 months. At baseline, pain scores ranged from 5.4 to 8, at 1-4 weeks from 0.5 to 5, and at 12 weeks from 0.3 to 4.5. Mean pain reduction compared with baseline ranged from 26 to 91% at 4 weeks and from 16% to 95% at 12 weeks. MWA treatments caused no complications, whereas MRgFUS showed the highest complication rate. The number of minor complications observed ranged from 0 to 59 (complication ratio 0-1.17), whereas the number of significant adverse effects ranged from 0 to 4 (complication ratio 0-0.04).
All techniques achieved pain relief after 1 and 3 months, in up to 91% and 95% of patients respectively. MWA showed a negligible complication rate, whereas MRgFUS is associated with a noteworthy rate of adverse events. Future studies should adopt a standardized pain reporting scale to allow for meta-analysis.
回顾经皮热消融（TA）治疗骨转移瘤（射频消融[RFA]、微波消融[MWA]、冷冻消融[CA]和磁共振引导聚焦超声[MRgFUS]）在减轻晚期癌症患者疼痛方面的疗效。
我们使用关键词“消融”、“疼痛”、“骨”和“转移”组合成多个算法，在 MEDLINE/PubMed、MEDLINE In-Process、BIDS ISI、Embase、CINAHL 和 Cochrane 数据库中进行了检索。纳入标准为：2001 年至 2018 年发表的原始临床研究；行 RFA、MWA、CA 或 MRgFUS 治疗；骨转移瘤 TA 前后进行定量疼痛评估。
共纳入 11 篇文献（3 篇关于 RFA，1 篇关于 MWA，2 篇关于 CA，5 篇关于 MRgFUS），涉及 364 例患者。报道的技术成功率为 96-100%，随访时间最长达 6 个月。基线时疼痛评分范围为 5.4 至 8，1-4 周时为 0.5 至 5，12 周时为 0.3 至 4.5。与基线相比，4 周时疼痛缓解率为 26-91%，12 周时为 16-95%。MWA 治疗无并发症，而 MRgFUS 显示的并发症发生率最高。观察到的轻微并发症数量为 0 至 59（并发症比例 0-1.17），而严重不良事件数量为 0 至 4（并发症比例 0-0.04）。
所有技术在 1 个月和 3 个月时均能缓解疼痛，分别有高达 91%和 95%的患者有效。MWA 的并发症发生率较低，而 MRgFUS 则与较高的不良事件发生率相关。未来的研究应采用标准化的疼痛报告量表，以便进行荟萃分析。
