Radiofrequency ablation (RFA) has been established as an effective minimally invasive treatment option for locoregional tumor therapy. It uses high-frequency energy to create heat resulting in controlled cell death. RFA is a valuable palliation procedure and is usually reserved for selective symptomatic lesions that are not acceptable surgical targets (e.g. in patients who are not safe surgical candidates).
The OsteoCool Ablation System by Medtronic uses this technology with controlled “cooling” to allow palliative treatment in metastatic malignant osseous lesions, usually in the vertebra. This provides interventional radiologists an additional tool to offer improved quality of life in patients with significant pain from bony metastases. Patients with localized painful metastasis not controlled with conservative management are the ideal candidates for RFA. The OsteoCool system has the added benefit of performing cementoplasty following ablation to also reduce the patients underlying high risk of pathologic fractures.
In a recent study, 90% patients had significant sustained pain relief following spinal OsteoCool until the moment of death(1). Similar lesions treated with external radiation alone have demonstrated less than 23% complete pain relief and reported 53-88% partial response over time(2). Lesions treated with OsteoCool are still amenable to external beam radiation for synergistic effects(3). Often times, OsteoCool of a stress-bearing lesion is performed prior to radiation to prevent potential pathologic fracture following radiation(4). The SSM Interventional Radiologists routinely collaborate with our Radiation Oncologists to develop the appropriate treatment plan.
OsteoCool has an FDA approved indication for spinal metastasis with recent expanded indication for palliative treatment of all bony metastasis. It is now offered at both St Josephs’ Hospitals and has been in use successfully. In an inpatient setting, it allows for faster pain control and reduced hospital stay. Overall, it allows for improved quality of life and reduced opiate use.
(1) Rosian K, Hawlik K, et al. Efficacy Assessment of Radiofrequency Ablation as a Palliative Pain Treatment in Patients with Painful Metastatic Spinal Lesions: A Systematic Review. Pain Physician. 2018 Sep;21(5):E467-E476.
(2) Lutz S, Balboni T, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Practical Radiation Oncology. (2017) 7, 4-12
(3) Di Staso M, Gravina GL, et al. Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients. PLoS One. 2015;10:e0129021.
(4) Agarwal MG, Nayak P. Management of skeletal metastases: An orthopaedic surgeon’s guide. Indian J Orthop. 2015;49(1):83-100.