Traitement des métastases osseuses par radiologie interventionnelle

Traitement
des métastases osseuses
par radiologie interventionnelle
(suite)
Réunion 3C – 31 mai 2013
Iñaki ZUAZO
Radiologie – CHCB Bayonne

Radiofréquence - généralités
•RF est un courant électromagnétique (300 à 500 kHz)
transmis par une électrode introduite sous guidage
radiologique dans la tumeur
 agitation ionique  élévation thermique
 mort cellulaire irréversible quand >70°C
•But: contrôle du volume tumoral et destruction des
terminaisons nerveuses nociceptives
•Efficacité antalgique: 70 à 90%
•Utilisation plus ancienne pour les ostéomes ostéoïdes
avec d’excellents résultats, ainsi qu’au niveau pulmonaire-
hépatique-rénal

Percutaneous image-guided radiofrequency ablation of painful metastases
involving bone: a multicenter study.
Goetz MP - Department of Oncology, Mayo Clinic - J ClinOncol 2004 Jan15;22(2):300-6.
PURPOSE:
. We sought to determine the benefit of radiofrequency ablation (RFA) in providing pain
relief for patients with refractory pain secondary to metastases involving bone.
PATIENTS AND METHODS:
31 US and 12 European patients with painful osteolytic metastases. > or = 4/10 pain and
failed or poor candidates for radiation or opioid analgesics.
RESULTS:
43 patients were treated (median follow-up, 16 weeks). Before RFA, the mean score for
worst pain was 7.9. 4, 12, and 24 weeks following treatment, worst pain decreased to
4.5 (P <.0001), 3.0 (P <.0001), and 1.4 (P =.0005). 95% (41/43 patients) experienced a
decrease in pain that was considered clinically significant. Opioid usage significantly
decreased at weeks 8 and 12. Adverse events were seen in 3 patients: skin burn,
transient bowel and bladder incontinence, fracture of the acetabulum.
CONCLUSION:
RFA of painful osteolytic metastases provides significant pain relief for cancer patients
who have failed standard treatments.

Percutaneous Radiofrequency Ablation of Painful Osseous Metastases
A Multicenter American College of Radiology Imaging Network Trial
Damian E. Dupuy, MD; Dawei Liu, PhD; Donna Hartfeil, RN; Lucy Hanna, MS, MAT; Jeffrey D.
Blume, PhD;Kamran Ahrar, MD; Robert Lopez, MD; Howard Safran, MD; and Thomas
DiPetrillo, MD
BACKGROUND: The study was conducted to determine whether radiofrequency
ablation (RFA) can safely reduce pain from osseous metastatic disease.
METHODS: The single-arm prospective trial included patients with a single painful
bone metastasis with unremitting pain with a score >50 on a pain scale of 0-100.
RESULTS: 55 patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%)
patients. RFA reduced pain at 1 and 3 months for all pain assessment measures.
The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9
(P <.0001) and 14.2 for 3-month follow-up (P=0.02).
CONCLUSIONS: This cooperative group trial strongly suggests that RFA can safely
palliate pain from bone metastases.
Cancer 2010;116:989–97. VC 2010 American Cancer Society

Jeune homme de 21 ans
Douleurs de l’épaule droite persistantes à 10 mois d’une acromioplastie