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indications and contraindications

The best indications of RF ablation of bone metatases are:

Painful osteolytic bone metastases with or without soft tissue invasion
Ablation of large bone metastases in thyroid cancer associated to radioisotope therapy (131 iodine)Radiofrequency is able to produce a much more predictable lesion than alcohol.  This technique was first applied to tumor and pain management if alcoholization was contraindicated (risk of intra-articular leak, risk of accidental neurolysis).

Radiofrequency is an effective solution in sensitive regions because of the predictable size and well-shaped lesion produced by this technique.  Furthermore there is no risk of leakage or collateral damage.

The distribution of alcohol is uneven within the tumor (particularly in large metastases).  Either the needle has to be repositioned in regions of poor diffusion or multiple needles should be used. However, alcoholization is a relatively cost-effective technique.

In bone metastases with risk of pathological fracture, a consolidation method should complete RF ablation.  For spinal and acetabular metastases, cementoplasty is an excellent alternative.  In case of large invasion of soft tissue surrounding the vertebral body, RF ablation can be combined with vertebroplasty.  However, the pain relief achieved by vertebroplasty and acetabular cementoplasty seems to be sufficient in lesions limited to vertebral body and acetabulum.

The usual contraindications are the same as the RF ablation of the liver.  For the ablation of bone metastases, the monopolar technique (conventional RF) is contraindicated if the lesion is close to neurological structures or sensitive organs (colon, intestine).  In these cases, the bipolar technique can be used for a precise limitation of the coagulation.  Bone tumors consolidated with osteosynthesis should be avoided particularly when the electrode is close to metallic structures.

 

Painful osteolytic metastases are the best indications of RF ablation.