Radiofrequency Ablation and Osteoplasty

Radiofrequency Ablation and Osteoplasty

PEP Topic 
Refractory/Intractable Pain
Description 

Radiofrequency ablation is a procedure in which the electrical conduction system of tissue is destroyed using heat generated from high-frequency radio waves. Osteoplasty is the surgical repair, replacement, or grafting of bone tissue. The of combination ablation by needle and electrode insertion into bone lesions followed by an injection of bone cement was evaluated for its effect on refractory pain from bone metastases.

Effectiveness Not Established

Research Evidence Summaries

Tian, Q.H., Wu, C.G., Gu, Y.F., He, C.J., Li, M.H., & Cheng, Y.D. (2014). Combination radiofrequency ablation and percutaneous osteoplasty for palliative treatment of painful extraspinal bone metastasis: A single-center experience. Journal of Vascular and Interventional Radiology, 25, 1094–1100. 

doi: 10.1016/j.jvir.2014.03.018
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Study Purpose:

To determine the efficacy and safety of radiofrequency ablation with percutaneous osteoplasty in the treatment of painful extraspinal bone metastases resistant to the conventional treatment of pain

Intervention Characteristics/Basic Study Process:

Radiofrequency ablation involved the insertion of a needle at the bone lesion using a local anesthetic. An electrode was inserted into the needle and delivered heat from 70–90°C for a mean duration of 8.6 minutes. Immediately after this procedure, bone cement was injected into the lesion through the needle. The procedure was guided by fluoroscopy, and the amount of bone cement was determined by measuring the tumor size (the mean volume of bone cement was 6.6 ml; SD = 4.6 ml). The patient underwent a computed tomography scan after the injection of bone cement. Study measurements took place at baseline, 24 hours after treatment, and at the three- and six-month follow-up.

Sample Characteristics:

  • N = 38  
  • MEAN AGE = 52.6 years (SD = 12.2 years)
  • MALES: 53%, FEMALES: 47%
  • KEY DISEASE CHARACTERISTICS: Most frequent diagnosis was lung cancer followed by breast, thyroid, and liver cancers with a life expectancy of less than three months; number of treated lesions ranged from one to three

Setting:

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Shanghai, China

Phase of Care and Clinical Applications:

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Palliative care 

Study Design:

Retrospective, single-arm, repeated-measures study; patients served as their own controls

Measurement Instruments/Methods:

Pain was measured by a 0–10 Visual Analog Scale (VAS), and quality of life was assessed using the Karnofsky Performance Status (KPS) scale. Data were collected by one physician at baseline and 24 hours after the intervention. Follow-up measurements (three and six months) were made at the outpatient office visit or by a telephone interview. Pain medication used by the patient was also documented. Functional recovery was evaluated by the patient’s ability to walk, and technical success was determined by the absence of major complications as defined by the Society of Interventional Radiology.

Results:

There was significant pain reduction (p < 0.001) compared to baseline as measured by the VAS at baseline, 24 hours, three months, and six months. Also at these time points, quality of life significantly improved (p < 0.05) as measured by the Karnofsky performance scale. Six months later, 32 patients no longer used narcotic analgesia (eight of these patients now used NSAIDs). Ten of the 25 patients who had limited walking ability before treatment were able to walk immediately after treatment. Six months later, 16 of the 25 patients’ ability to walk increased and walking became normal for five patients. Walking ability was worse for two patients. One patient experienced a vasovagal reaction during the procedure which may have been related to the lesion location. Minor complication rate was 23.7% and included 8 episodes of a small cement leakage into the soft tissue (resolved within 24 hours) and one episode of first-degree skin burns.

Conclusions:

Radiofrequency ablation with percutaneous osteoplasty is a new treatment that shows promise for treating painful bone metastases. Although this study demonstrates its safety, efficacy, and feasibility, further study is needed with a larger number of patients.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Findings not generalizable
  • Other limitations/explanation: All patients were from one medical center.

Nursing Implications:

Radiofrequency ablation with percutaneous osteoplasty is a palliative care intervention that nurses should be aware of as they may be caring for patients who receive this treatment once additional scientific evidence is established. Nurses should be knowledgeable of potential complications that may result from the procedure (i.e., skin burns, cement leakage).

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