Percutaneous MRI guided cryoablation of painful skeletal metastasis.

Our purpose is to detail the results of our experience with percutaneous MRI guided cryoablation of painful bone metastasis with regard to pain relief. Thirty-two patients with 46 individual tumors underwent MRI guided percutaneous cryoablation to provide palliative care for their painful bone metastasis. Most patients were suffering from significant pain requiring large doses of narcotics and some patients were selected to prevent further bony destruction. All patients were treated as in-patients in an IRB approved clinical trial. Each patient was followed closely using MRI and CT imaging. Data regarding complications and the need for re-treatment were correlated with tumor size, location, and clinical outcomes from prior treatments. The source of the metastasis included breast cancer, renal cell carcinoma, colon cancer, and lung cancer. Two patients had primary benign bone tumor (osteoid osteoma) and one patient had a metastatic pulmonary carcinoid tumor to the body of the second cervical vertebrae. The vast majority of the patients achieved significant postoperative pain relief in the immediate post-operative period. One patient treated for neuropathic pain along the third through eighth ribs experienced only temporary relief. After approximately 24 hours, his pain returned. Tumor locations included lesions in the appendicular and axial skeleton. The most painful were those destroying the vertebral body, usually metastatic renal cell carcinoma. Several unusual sites of metastasis that would normally require difficult surgical resection and a high level of morbidity and mortality were treated successfully with this minimally invasive method. Percutaneous MRI guided cryoablation of painful skeletal metastasis demonstrated significant and nearly complete pain relief with long lasting results, low morbidity, and zero mortality. The ability to provide immediate and sustained pain relief is a significant advantage over comparative treatments such as external beam radiation.

Jeff Howard, MD, and Patrick Sewell, MD. Department of Radiology, The University of Mississippi Medical Center, Jackson, MS.