Ablation of skeletal metastases

Author, year	Ablation type	Number of patients	Number of tumors	Median follow-up in months	Pain reduction* (number of patients achieving, mean decrease in pain intensity^¶)	Opioid reduction (MEDD or % of patients using less opioids)	Number of major complications
Callstrom M, 2006	RFA	62	62	6	59 of 62, 7.7 to 2.4 over 24 weeks^Δ	MEDD reduced from 66 to 44 mg at 214 weeks	4
Dupuy D, 2009	RFA	55	55	3	NR, 14.2^◊	NR	3
Bagla S, 2016	RFA	50 (spine)	69	NR	24 of 34; decrease in pain intensity (numerical pain rating scale^Δ) from 5.9 to 2.1 over 3 months	NR	NR
Callstrom M, 2013	Cryo	61	69	6	42 of 61, 7.1 to 1.4 over 24 weeks^Δ	83%	1
Tomasian A, 2015^§	Cryo	14	31	10	All 14; from 8 to 3 over 12 weeks	MEDD reduced from 360 to 80 mg per day at 12 weeks	2
Liberman B, 2009	FUS	31	32	3	18 of 25, 5.9 to 1.8 over 12 weeks^Δ	67%	0
Hurwitz M, 2014	FUS	112	NR	NR	72 of 112 versus 7 of 35 control^¥, mean decrease in pain intensity 7.0 to 3.4 over 12 weeks (versus 6.8 to 6.1 control)	44% at 12 weeks (versus 14% in control arm)	3
Hurwitz M, 2014	Sham control	35	NR	NR		44% at 12 weeks (versus 14% in control arm)	3

MEDD: morphine equivalent daily dose; RFA: radiofrequency ablation; NR: not reported; Cryo: cryoablation; FUS: focused ultrasound.
* Clinically significant pain reduction defined variably; refer to related UpToDate topic.
¶ As indicated by a mean decrease in Visual Analog Score for pain.
Δ Scale of 1 to 10.
◊ 100-point scale, mean difference in pain intensity from baseline.
§ Spine lesions only.
¥ Patients whose worst numerical rating scale assessment for pain decreased by at least 2 points and whose MEDD intake did not increase by more than 25% from baseline to 3 months were considered responders.

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Ablation of skeletal metastases