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NEW YORK (Reuters Health) – Radiofrequency ablation (RFA) for the palliative treatment of patients whose cancer has spread to the bone provides rapid and sustained pain relief and improves quality of life, according to new research.
Radiation treatments have been commonly used for osseous metastases, but pain relief can takes “weeks to occur and in this palliative-care population that can represent a significant portion of the remaining life for these patients,” lead researcher Dr. Jason R. Levy of Northside Hospital, in Atlanta, said during a press briefing at the Society of Interventional Radiology Annual Scientific Meeting, where the findings will be presented.
“RFA uses radiofrequency waves to create heat and that heat kills the tumor cells and destroys some of the nerve fibers, both of which reduce or stop transmission of pain and signals of pain to the brain,” he explained.
In a prospective study conducted in Europe, the United States and Canada, 206 patients underwent palliative RFA for painful metastatic bone lesions, followed by cement injection to help stabilize the bone.
The most common cancer types were breast, lung and renal cancer. Most patients underwent RFA to treat metastatic lesions involving the lumbar or thoracic spine; some were treated for metastatic lesions located in the iliac crest, periacetabulum, sacrum or mixed vertebral and pelvic locations.
Patients were assessed as early as three days after RFA and intermittently throughout one year using standard measures of pain and quality of life.
“We were really excited by what we saw,” Dr. Levy told the briefing.
RFA was safe and led to significant improvements in pain (worst pain and average pain) at all visits and as soon as day three after the procedure. “Obviously, this is very significant given the population and especially when you consider the standard of care right now, radiation, takes four to six weeks,” Dr. Levy said.
Pain relief was also durable, with 83% of patients reporting clinically meaningful improvement in their pain 12 months after RFA. Pain relief was accompanied by significant improvements in quality of life.
“This treatment is an option for a wide range of cancer patients and I believe this treatment should be available earlier in their treatment path,” Dr. Levy said.
Commenting on this research for Reuters Health, Dr. Brett Hayden, Assistant Professor of Orthopaedic Surgery at the Ichan School of Medicine at Mount Sinai in New York, noted that “patients with cancer are living longer, and so the number and the prevalence of bone metastases is increasing.”
Bone metastases “basically cause a hole in the bone, which makes the bone mechanically weaker and causes pain, which can affect quality of life,” he explained by phone.
“The bigger issue is when there’s a hole of bone, there’s a potential for a fracture. Preventing these fractures is really important and (RFA) is a potential treatment in order to potentially prevent one of the catastrophic sequela of bone metastases,” said Dr. Hayden.
“From an orthopedic perspective,” he added, “filling in the hole with cement is an important part of this procedure in terms of pain control and bony stabilization because it provides structural support.”
Clearly, said Dr. Hayden, one of the main benefits of RFA is fast pain relief. “The caveat is that this is a very specific treatment and we have to choose patients appropriately for this treatment. Most of these patients had tumors in the spine not in the long bones – meaning the femur, the tibia, the humerus – which are more at risk for fracture,” he noted.
The study was funded by Medtronic. Dr. Levy several co-authors have financial relationships with the company.
SOURCE: https://www.sirweb.org/ Society of Interventional Radiology (SIR) Annual Scientific Meeting, March 20-26, 2021.
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