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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article iscussed advances in radio-frequency ablation for osteoid osteoma and other benign bone tumors. Other topics include cryoablation and microwave ablation for the treatment of bone metastases, and magnetic resonance\u2013guided focused ultrasound for palliative treatment of painful bone metastases.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etumors\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMark Richard Robbin, MD, University Hospitals, Cleveland, Ohio, USA, discussed advances in radiofrequency ablation (RFA) for osteoid osteoma and other benign bone tumors. RFA involves the insertion of an electrode into the target tissue under medical imaging guidance. The electrode is then heated with a radiofrequency electric current to destroy the target tissue.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EDr Robbin performs RFA under general anesthesia and uses preprocedural thin-slice computed tomography (CT) for access planning. He administers 2 sequential 6-minute ablations at 90\u00b0C. A retrospective study of this technique demonstrated a 100% short-term success rate and a 0% recurrence rate at 5.2 (1.0 to 12.7) years, with 1 delayed stress injury after early return to sports [Abboud S et al. SIR 2014 (abstr 239)].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EA study of CT-guided RFA for nonspinal osteoid osteomas reported that a dual ablation cycle decreased tissue impedance, had greater potential for killing peripheral residual tumor foci, allowed electrode repositioning, and resulted in greater success rates (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Rimondi E et al. \u003Cem\u003EEur Radiol.\u003C\/em\u003E 2012]. Gradually increasing the temperature and prolonging ablation times also improved outcomes.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16486\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16486\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16486\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EImproved Outcomes With Dual-Cycle Radiofrequency Ablation for Osteoid Osteomas\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16487\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16487\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16487\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EHeat Generation in Tissue With Radiofrequency and Microwave Ablation\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EAccording to Dr Robbin, a 6-minute ablation may not be sufficient for treating recurrences and larger lesions. Margins can be difficult to define in postsurgical recurrences. The volume and longitudinal extent of the lesion must be calculated to define the complete ablation zone.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ESelected cases of chondroblastoma can be treated with RFA. In one study, 12 of 14 patients were pain free after long-term follow-up [Rybak LD et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2009]. Giant cell tumors and aneurysmal bone cysts may also be treated with RFA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDamian E. Dupuy, MD, Brown University, Providence, Rhode Island, USA, discussed cryoablation and microwave ablation (MWA) for the treatment of bone metastases. The goals of ablation are to achieve local control and pain palliation. Ablation can be used in combination with radiation therapy and vertebroplasty.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EThe cryoablation technique employs a rapid freeze and slow-thaw cycle, resulting in cell shrinkage and rupture and small blood vessel clotting. The cytotoxic threshold is \u221240\u00b0C. Cryoablation systems are argon based. The ice ball is visible with CT, ultrasound (US), and magnetic resonance imaging (MRI). Cryoablation is relatively painless during treatment. Larger ablation volumes can be achieved than with RFA, without disruption of collagenous architecture. Treated tissue is not denatured, allowing quicker absorption of dead tissue.\u003C\/p\u003E\n         \u003Cp\u003EThe advantages of cryoablation include the following:\n\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-14\u0022\u003EIce ball visualization\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-15\u0022\u003ELethal zone 3 to 5 mm within margin\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-16\u0022\u003ETreatment close to critical structures\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n                  \u003Cp id=\u0022p-17\u0022\u003ERelatively painless\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n                  \u003Cp id=\u0022p-18\u0022\u003ENo need for general anesthesia\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EA multicenter trial of percutaneous image-guided cryoablation of painful bone metastases reported that treatment with cryoablation significantly decreased the mean score for worst pain (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001) and there was 1 postprocedural osteomyelitis [Callstrom MR et al. \u003Cem\u003ECancer.\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EThermal myositis is a potential adverse effect, especially in larger ablation zones, but usually it is asymptomatic; however, pain medication may be needed in some cases [Bing F et al. \u003Cem\u003EAJR Am J Roentgenol.\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EMWA is performed with high-frequency electromagnetic radiation at 1 or 2.45 GHz. The oscillation of polar molecules produces frictional heating without an electrical current. \u003Ca id=\u0022xref-table-wrap-2-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E compares the heat generation of MWA with RFA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EMWA has the following advantages over RFA: The use of multiple applicators increases treatment flexibility, large tissue volumes can be ablated in shorter time periods [Laeseke PF et al. \u003Cem\u003EJ Vasc Interv Radiol.\u003C\/em\u003E 2009], the heat sink effect is much smaller [Dodd GD et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2013], MWA may be more effective [Brace CL et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2009], and MWA appears to be less painful. In a study of MWA for painful bone metastases, the Brief Pain Inventory score declined by 92% during 3 months of follow-up [Pusceddu C et al. \u003Cem\u003EJ Vasc Interv Radiol.\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EDramatic and persistent pain reduction with MWA also has been demonstrated in patients with painful refractory spinal metastases [Kastler A et al. \u003Cem\u003EJ Vasc Interv Radiol.\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe evidence demonstrates that bone cryoablation and MWA are safe and appear promising for palliation of metastatic bone disease. Margin control and low pain are key advantages of cryoablation. An important advantage of MWA is the fast treatment time, even in large tumors. Further clinical studies of both procedures are warranted.\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003EDavid Gianfelice, MD, University Health Network, Toronto, Ontario, Canada, addressed magnetic resonance\u2013guided focused ultrasound (MRgFUS) for palliative treatment of painful bone metastases. External beam radiation is the gold standard for treatment of bone metastases, but at least 30% of patients do not get adequate pain relief. MRgFUS is performed with an US transducer located in a standard MR table without needle or probe placement. High-energy US waves increase the temperature in target tissues, which become necrotic above 60\u00b0C. Heating bone above 60\u00b0C effectively destroys the periosteal innervation for pain palliation. Because FUS energy absorption by bone is approximately 50 times greater than that of soft tissue, bone can be treated with a low-energy, wide-beam approach for a short treatment time.\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003EA pilot study of MRgFUS in 11 patients with bone metastases reported a progressive reduction in pain and pain medication usage in all patients during the 3-month follow-up, with a 92% decrease in pain scores (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Gianfelice D et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2008]. No adverse events were reported.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Pain Palliation with Magnetic Resonance\u0026#x2013;Guided Focused Ultrasound Treatment of Bone Metastases\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-478735954\u0022 data-figure-caption=\u0022Pain Palliation with Magnetic Resonance\u0026#x2013;Guided Focused Ultrasound Treatment of Bone Metastases\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16393\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-27\u0022 class=\u0022first-child\u0022\u003EPain Palliation with Magnetic Resonance\u2013Guided Focused Ultrasound Treatment of Bone Metastases\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from Gianfelice D et al. Palliative treatment of painful bone metastases with MR imaging\u2013guided focused ultrasound. \u003Cem\u003ERadiology.\u003C\/em\u003E 2008;249:355\u2013363. With permission from the Radiological Society of North America.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-28\u0022\u003EThe pivotal phase 3 trial of MRgFUS demonstrated that MRgFUS is safe and effective for pain palliation in patients with metastatic bone lesions who were not suitable candidates for radiation therapy [Hurwitz MD et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2014]. The response rate at 90 days was 64.3% in the MRgFUS arm vs 20.0% in the placebo arm. Quality-of-life improvement was clinically significant. The most common treatment-related adverse event was sonication pain (32.1%).\u003C\/p\u003E\n         \u003Cp id=\u0022p-29\u0022\u003EMRgFUS treatment of bone metastases does not require image-guided interventional skills. It is effective for short-term pain relief and is a viable palliative treatment. MRgFUS is an outpatient procedure with few or no adverse events and is repeatable with little morbidity. Future treatment protocols aim to achieve complete ablation of the medullary component of osteolytic metastases to achieve local tumor control and pain palliation.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlseq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlseq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlseq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}