CIRSE Standards of Practice on Thermal Ablation of Bone Tumours

Abstract

Background Percutaneous thermal ablation is an effective, minimally invasive means of treating a variety of focal benign and malignant osseous lesions. To determine the role of ablation in individual cases, multidisciplinary team (MDT) discussion is required to assess the suitability and feasibility of a thermal ablative approach, to select the most appropriate technique and to set the goals of treatment i.e. curative or palliative. Purpose This document will presume the indication for treatment is clear and approved by the MDT and will define the standards required for the performance of each modality. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of thermal ablation of bone tumours. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in thermal ablation of bone tumours. The writing group reviewed the existing literature on thermal ablation of bone tumours, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects from 2009 to 2019. Selected studies published in 2020 and 2021 during the course of writing these standards were subsequently included. The final recommendations were formulated through consensus. Results Recommendations were produced for the performance of thermal ablation of bone tumours taking into account the biologic behaviour of the tumour and the therapeutic intent of the procedure. Recommendations are provided based on lesion characteristics and thermal modality, for the use of tissue monitoring and protection, and for the appropriately timed application of adjunctive procedures such as osseus consolidation and transarterial embolisation. Results Percutaneous thermal ablation has an established role in the successful management of bone lesions, with both curative and palliative intent. This Standards of Practice document provides up-to-date recommendations for the safe performance of thermal ablation of bone tumours.

Safety and Feasibility of Steerable Radiofrequency Ablation in Combination with Cementoplasty for the Treatment of Large Extraspinal Bone Metastases

“…A multidisciplinary team discussion is required to assess the correct clinical and therapeutic pathway for patients with bone metastases and to select the most appropriate thermal ablative approach [ 6 ].…”

“…Technical success was defined as a successful intraoperative ablation and cementoplasty without any major complications. Major and minor complications were evaluated based on the CIRSE classification system [ 6 ].…”

Clinical Rationale of Using Steerable Technologies for Radiofrequency Ablation Followed by Cavity Creation and Cement Augmentation in the Treatment of Painful Spinal Metastases

“…Radiofrequency ablation is a well-established modality for the treatment of metastatic spinal disease based on predictable energy delivery and a controlled ablation zone, both properties that limit potential damage to surrounding tissues and nerves. The role of radiofrequency ablation in combination with vertebral augmentation has been included in the current guidelines from scientific societies (CIRSE Standards of Practice on Thermal Ablation of Bone Tumors [ 13 ], The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain [ 14 ]) and guidelines in Oncology (Bone health in cancer: ESMO Clinical Practice Guidelines [ 15 ] and NCCN Adult Cancer Pain Guideline [ 16 ]). Vertebral augmentation alone has been shown to be ineffective and unsafe in the treatment of spinal metastases, as the incidence of cement leakage for spinal metastases is approximately 50% to 85% [ 4 , 17 ], and bone cement alone has no anti-neoplastic effect [ 2 ], increasing the risk of local recurrence [ 18 ].…”

Interventional management of malignant bone tumours

“…However, in selected patients presenting with good life expectancy, and oligometastatic or oligoprogressive status, complete local tumour control of the target BM may be the desired goal. 1,7,8 With IR treatments, this is particularly accomplished in patients presenting with small BM (usually sized 2 cm or less), and without any extra-cortical extension. 1,7,8 Based on this 'palliativecurative' paradigm, the multidisciplinary tumour board can select the best patient-tailored treatment, which may include surgery, IR, radiation therapy (RT) and systemic treatments, as well as a combination of two or more of these treatments.…”

“…In the last few decades interventional radiology (IR) has significantly increased its role in the management of bone tumours. 1 IR has reached the status of first-linetherapy for some benign bone tumours such as osteoid osteomas and osteoblastomas 2 ; and it is increasingly involved in the management of bone metastases (BM), 3 that definitively represent the most common type of bone tumour. Conversely, the role of IR remains very limited in the management of primary malignant bone tumours (i.e.…”