Radiofrequency thermal ablation (RFTA) has recently been introduced for the treatment of painful bone metastases. We report the outcome of one combined protocol session of percutaneous RFTA and cementoplasty on a painful sternal breast cancer metastasis of a 66-year-old patient

Bartolucci, DA

Formica, V

Mammucari, M

Manenti, G

Masala, S

Massari, F

Roselli, M

Simonetti, G

Archivio della Ricerca - Università di Roma Tor vergata

Abstract. Background: Radiofrequency thermal ablation
(RFTA) has recently been introduced for the treatment of
painful bone metastases. We report the outcome of one
combined protocol session of percutaneous RFTA and
cementoplasty on a painful sternal breast cancer metastasis of
a 66-year-old patient. Patients and Methods: A sternal lesion
was identified at a repeated CT scan during the oncological
follow-up. Due to severe chest pain, the patient was treated
percutaneously to obtain pain relief and bone stabilization.
Percutaneous RFTA was performed using a 15-gauge needle
electrode (MIRAS TX-120) coaxially introduced through a 13-
gauge bone biopsy needle. The lesion was heated up to 80ÆC
for 3 minutes. A percutaneous injection of 1 cc
polymethylmethacrylate in the central part of the lesion was
performed immediately after the RFTA procedure. Results:
Immediate symptomatic improvement was documented.
Conclusion: Combined percutaneous therapy showed
feasibility and effectiveness and can be considered as an
alternative for the treatment of painful bone metastases.
Bone metastases are common in cancer patients, most often
in breast, lung or prostate cancer (1-2). In fact, bone
metastases from such tumors are demonstrated up to 85%
post-mortem autopsies (3). The most common symptom
associated with bone metastases is severe pain that can
dramatically affect a patient’s quality of life (1-3). Because
of the usual advanced stage of disease at the time of
presentation, current treatments are aimed at pain
palliation and/or at complications prevention and hospital
admission reduction. Standard treatments include radiation
therapy, chemotherapy, hormone therapy and analgesic
medications (4-5). Radiation therapy (RT) may be effective
for pain relief and is the treatment of choice for painful
bone metastases. Nonetheless, up to 20-30% of patients
treated with RT do not respond to the treatment.
Furthermore, patients who experience pain recurrence at a
previously irradiated site might not be suitable for further
irradiation due to dose limits in normal tissues (6).
Radiofrequency thermal ablation (RFTA) uses a high-
frequency alternating current producing a focal thermal injury
of tumor cells (7-8). The technique has been tested in several
organs, for treatment of both benign and malignant tumours.
With regard to musculoskeletal diseases, it has been used for
osteoid osteomas, chondroblastomas, epithelioid hema-
ngioendotheliomas, chordomas and spinal metastases (9).
Recently, a combined therapy of RFTA and cementoplasty
for painful bone metastases was introduced (10).
Patients and Methods 
A 66-year-old woman with a medical history of endocrine-
responsive right breast cancer treated with neoadjuvant
chemotherapy followed by breast conservative surgery plus
adjuvant chemotherapy and radiotherapy was put on long-term
hormonal therapy with anastrozole.
After two years of follow-up, a fluorine-18 fluorodeoxyglucose
positron-emission tomography/computerized tomography (FDG
PET-CT) scan showed pathological radioactive tracer uptake in the
right breast, mediastinal lymph nodes and corpus sterni (Figure 1).
The same oblate lesion was evidenced at bone scintigraphy. A
gemcitabine-cisplatin based chemotherapy was started as first-line
treatment for metastatic disease and after three months of therapy a
complete radiological regression was demonstrated in all metastatic
sites but the sternal one.
As severe anterior chest wall pain still persisted, even with
optimal systemic analgesia treatment, a course of radiation therapy
4259
Correspondence to: Salvatore Masala, MD, Ph.D, "Tor Vergata"
University Hospital, Department of Diagnostic Imaging, Molecular
Imaging, Interventional Radiology and Radiation Therapy, Viale
Oxford 81, 00133 Rome, Italy. Tel: +39 06 2090 8190, Fax: +39 06
2090 3692, e-mail: salva.masala@tiscali.it
Key Words: Bone metastases, radiofrequency thermal ablation,
cementoplasty, breast cancer.
ANTICANCER RESEARCH 27: 4259-4262 (2007)
Percutaneous Combined Therapy for Painful 
Sternal Metastases: A Radiofrequency Thermal 
Ablation (RFTA) and Cementoplasty Protocol
SALVATORE MASALA1, GUGLIELMO MANENTI1, MARIO ROSELLI2, 
MATTEO MAMMUCARI1, DARIO ALBERTO BARTOLUCCI1, VINCENZO FORMICA2, 
FRANCESCO MASSARI1 and GIOVANNI SIMONETTI1
1Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, and
2Department of Medical Oncology, "Tor Vergata" University Hospital, Rome, Italy 
0250-7005/2007 $2.00+.40
to the sternal region was delivered. After 6 weeks, no symptom
improvement was noted and a percutaneous treatment of the
localised metastasis was proposed. Informed consent was obtained.
Before the procedure a repeated CT scan confirmed a 23 mm
osteolytic sternal lesion at the 2nd-3rd rib articulation level.
RFTA was performed percutaneously under CT guidance. The
patient was posed in the supine position and the thorax was
prepared and draped in the usual sterile fashion. The lesion was
identified using the CT pointing system and 1% lidocaine local
anesthesia was administered through the skin. A small blade
incision was made and a hand-modified 13-gauge bone biopsy
needle was directed into the sternum. Under CT guidance, the
needle was gently advanced into the lesion. After diagnostic cyto-
aspiration, the 15-gauge RFTA needle (MIRAS TX-120, Invatec
Italia, Concesio, Italy) was placed through the biopsy needle and
the 3 spiral tines deployed up to 1 cm from the needle sheath
(Figure 2). A multi-tine expandable probe was used in order to
obtain entire lesion coverage. Correct placement of needle and
tines was CT confirmed. Ground pads were placed in the
supraclavear space to avoid the cardiac electrical axis and then
connected to the electrical circuitation.
The procedure was performed with a 40 W energy peak raising the
temperature up to 80ÆC for  3 minutes. A bone lesion RFTA
protocol commonly used for vertebral lesions less than 3 cm in
diameter was carried out. The procedure started with a 10 W energy
output, maintained up to three minutes in order to reduce the local
tissue impedence to 50-60 Ohm and then 10 W each further minute
up to a 40 W generator output and 80ÆC homogeneous temperature
at the thermocouple tips. These settings were maintained for about 3
minutes, in order to obtain entire lesion coagulative necrosis. In the
first 120-180 seconds, using such a low energy, it is possible to
optimize radiofrequency flowing at the tissue-electrode interface
without charring, distributing radiofrequency homogeneously while
reducing burning pain. The elapsed time for the entire procedure was
15-20 minutes.
A post-procedure CT scan confirmed the presence of gas
bubbles inside the bone lesion, which are commonly interpreted as
the immediate coagulation sign. Gas formation is due to
intracellular fluid evaporation after membrane disrupture after
extensive radiofrequency ionizing friction heating. Bubbles are
entrapped mainly in the outer soft tissue margins in face to
periosteum burdens.
Tines were then retracted and the needle removed from the
patient after a 2 minutes cool-down period.
Percutaneous injection of polymethylmethacrylate (PMMA)
(~1 cc) for bone stabilization using the biopsy needle as a guide
(Figure 3) was subsequently performed.
The patient was hospitalized for one night. No complication
occurred. Antibiotics were administered one day before and three
days after the procedure.
Results
The procedure was uneventful and patient experienced an
immediate pain relief.
Discussion
Metastatic cancer is the most common malignant bone
disease. Every year more than a half of the estimated 1.2
million new cases of cancer diagnosed in United States will
probably exhibit skeletal metastases (11).
Breast, lung and prostate cancer are responsible for more
than 85% of bone metastases (12). The most frequently
reported symptom of such lesions is pain. It may be
excruciating and so bring about a decrease in the patient’s
quality of life. Because of the advanced disease at the time
ANTICANCER RESEARCH 27: 4259-4262 (2007)
4260
Figure 1. PT/CT scan of sternal metastasis.
Masala et al: A Combined RFTA and Cementoplasty Protocol
4261
Figure 2. The RF needle has been positioned.
Figure 3. A) RF needle with partially deployed tines. B) RF needle positioning using CT control. Only tines are visible (arrow). C) MIP reconstruction:
RF needle with deployed tines positioned in the lesion. D) Gas bubbles (arrow) in the upper side of the lesion some minutes after the RFTA procedure.
E) Polymethylmethacrylate (PMMA) introduction after RFTA. F) MIP reconstruction: PMMA distribution in the lesion at the end of the procedure.
of presentation, current treatments are pain palliation,
aimed at preventing treatment complications and reducing
the hospital stay. Radiation therapy, chemotherapy,
hormone therapy and analgesic medications are all included
in standard palliation protocols. Currently, radiation therapy
is recognized as the most effective treatment, however 20-
30% of patients with painful bone metastases are non-
responders. Furthermore, patients who have recurrent pain
in a previously irradiated site may not be suitable for further
irradiation due to dose limits in normal tissue (7-8).
Percutaneous image-guided RFTA uses a high-frequency
alternating current that produces a focal thermal injury to
tumour cells. RFTA allows the destruction of tumor cells
without surgical removal and may be used instead of more
invasive, expensive and complicated techniques, often
unnecessary for patients with a short life expectancy. Pain
decrease is probably due to local sensory terms destruction
and cytokines being released as a result of the intense heat
of RFTA (13). This technique has been used to treat both
benign and malignant conditions in several organs. In the
musculoskeletal system, it is used to treat osteoid osteomas,
chondroblastomas, epithelioid hemangioendotheliomas,
chordomas and spinal metastases (9).
The integrity of the periosteum is of paramount
importance when RFTA is used for osteolytic bone lesions.
After the procedure is completed, thermal ablation
continues as heat is kept inside the insulating periosteum.
In a cool-down period following the retraction of the tines,
heat is irradiated from the charring tip producing tissue
necrosis nearby the needle track. This cool-down period,
with the energy output off, is variable among the different
bone lesions, mainly depending on cell density and lesion
diameter, as we previously found in swine.
To date, RFTA combined with cementoplasty is used on
the spine or other bearing bones with excellent results in
terms of long-term pain relief (14). RFTA and
cementoplasty are mutually enhanced because of the
homogeneous distribution cement of the inside the heated
tissue and the bone burdens.
As far as we know, there is no data in the literature on
the use of cementoplasty for sternal lesions. We aimed to
give a combined effect of pain relief and bone stabilization
of the osteolytic lesion. RFTA can be performed with no
sedation and in patients who would not  be suitable for
more invasive surgical procedures because of their age,
performance status or disease extension. The main
advantages of this protocol are the restricted range of
damage and the immediate pain relief that is reached with a
single-application therapy, while in contrast, RT has to be
extended for weeks. In our experience, mechanical or
thermal damage to the adjacent organs and structures such
as the pericardium, heart and major vessels were the most
important concerns. An accurate and repeated CT scan
control during needle positioning is the way to guarantee a
complication-free treatment. The position of the grounding
pads is another important aspect. In the case reported here
the  supraclavear space was preferred for positioning in
order to avoid electrical flow to the heart area.
The RFTA and cementoplasty combined therapy appears
to have a real efficacy against oncological pain and can be
considered as a true alternative to other palliative therapies.
The most important features of this approach are its rapid
action against pain and the limited duration of the
procedure.
References
1 Mercante S: Malignant bone pain: Pathophysiology and
treatment. Pain 69: 1-18, 1997.
2 Hage WD, Aboulafia AJ, Aboulafia DM et al: Incidence,
location, and diagnostic evaluation of metastatic bone disease.
Orthop Clin North Am 31: 515-528, 2000.
3 Nielsen OS, Munro AJ and Tannock IF: Bone metastases:
Pathophysiology and management policy. J Clin Oncol 9: 509-
524, 1991.
4 Janjan N: Bone metastases: approaches and management.
Semin Oncol 28: 28-34, 2001.
5 Schachar NS: An update on the nonoperative treatment of
patients with metastatic bone disease. Clin Orthop 328: 75-81,
2001.
6 Poullsen HS, Nielsen OS, Klee M et al: Palliative radiotherapy
in the treatment of skeletal metastasis. Eur J Pain 6: 323-330,
1989.
7 Gazelle GS, Goldberg SN, Solbiati L et al: Tumor ablation with
radio-frequency energy. Radiology 217:633-646, 2000.
8 Goetz MP, Callstrom MR, Charboneau JW et al: Percutaneous
image-guided radiofrequency ablation of painful metastases
involving bone: a multicentric study. J Clin Oncol 22: 300-306,
2004.
9 Rosenthal DI, Springfield DS, Gebhardt MC et al: Osteoid
osteoma: percutaneous radio-frequency ablation. Radiology
197: 451-454, 1995.
10 Toyota N, Naito A, Kakizawa H et al: Radiofrequency ablation
therapy combined with cementoplasty for painful bone
metastases: Initial experience. Cardiovasc Intervent Radiol 28:
578-583, 2005.
11 Stoll BA and Parbhoo S: Bone Metastasis: Monitoring and
Treatment, 1st ed., New York: Raven Press, pp. 1-20, 1983.
12 Janjan N: Bone metastases: approaches to management. Semin
Oncol 28: 28-34, 2001.
13 Callstrom MR, Charboneau JW, Goetz MP et al: Percutaneous
image-guided raediofrequency ablation of painful metastases
involving bone: a multicenter study. J Clin Oncol 22: 300-306,
2004.
14 Masala S, Roselli M, Massari F et al: Radiofrequency heat
ablation and vertebroplasty in the treatment of neoplastic
vertebral body fractures. Anticancer Res 24: 3129-3133, 2004.
Received July 24, 2007
Accepted August 6, 2007
ANTICANCER RESEARCH 27: 4259-4262 (2007)
4262


Percutaneous combined therapy for painful sternal metastases: a radiofrequency thermal ablation (RFTA) and cementoplasty protocol

MASALA, SALVATORE

MANENTI, GUGLIELMO

ROSELLI, MARIO

SIMONETTI, GIOVANNI MARIA EGISTO

Abstract. Background: Radiofrequency thermal ablation(RFTA) has recently been introduced for the treatment ofpainful bone metastases. We report the outcome of onecombined protocol session of percutaneous RFTA andcementoplasty on a painful sternal breast cancer metastasis ofa 66-year-old patient. Patients and Methods: A sternal lesionwas identified at a repeated CT scan during the oncologicalfollow-up. Due to severe chest pain, the patient was treatedpercutaneously to obtain pain relief and bone stabilization.Percutaneous RFTA was performed using a 15-gauge needleelectrode (MIRAS TX-120) coaxially introduced through a 13-gauge bone biopsy needle. The lesion was heated up to 80ÆCfor 3 minutes. A percutaneous injection of 1 ccpolymethylmethacrylate in the central part of the lesion wasperformed immediately after the RFTA procedure. Results:Immediate symptomatic improvement was documented.Conclusion: Combined percutaneous therapy showedfeasibility and effectiveness and can be considered as analternative for the treatment of painful bone metastases.Bone metastases are common in cancer patients, most oftenin breast, lung or prostate cancer (1-2). In fact, bonemetastases from such tumors are demonstrated up to 85%post-mortem autopsies (3). The most common symptomassociated with bone metastases is severe pain that candramatically affect a patient’s quality of life (1-3). Becauseof the usual advanced stage of disease at the time ofpresentation, current treatments are aimed at painpalliation and/or at complications prevention and hospitaladmission reduction. Standard treatments include radiationtherapy, chemotherapy, hormone therapy and analgesicmedications (4-5). Radiation therapy (RT) may be effectivefor pain relief and is the treatment of choice for painfulbone metastases. Nonetheless, up to 20-30% of patientstreated with RT do not respond to the treatment.Furthermore, patients who experience pain recurrence at apreviously irradiated site might not be suitable for furtherirradiation due to dose limits in normal tissues (6).Radiofrequency thermal ablation (RFTA) uses a high-frequency alternating current producing a focal thermal injuryof tumor cells (7-8). The technique has been tested in severalorgans, for treatment of both benign and malignant tumours.With regard to musculoskeletal diseases, it has been used forosteoid osteomas, chondroblastomas, epithelioid hema-ngioendotheliomas, chordomas and spinal metastases (9).Recently, a combined therapy of RFTA and cementoplastyfor painful bone metastases was introduced (10).Patients and Methods A 66-year-old woman with a medical history of endocrine-responsive right breast cancer treated with neoadjuvantchemotherapy followed by breast conservative surgery plusadjuvant chemotherapy and radiotherapy was put on long-termhormonal therapy with anastrozole.After two years of follow-up, a fluorine-18 fluorodeoxyglucosepositron-emission tomography/computerized tomography (FDGPET-CT) scan showed pathological radioactive tracer uptake in theright breast, mediastinal lymph nodes and corpus sterni (Figure 1).The same oblate lesion was evidenced at bone scintigraphy. Agemcitabine-cisplatin based chemotherapy was started as first-linetreatment for metastatic disease and after three months of therapy acomplete radiological regression was demonstrated in all metastaticsites but the sternal one.As severe anterior chest wall pain still persisted, even withoptimal systemic analgesia treatment, a course of radiation therapy4259Correspondence to: Salvatore Masala, MD, Ph.D, "Tor Vergata"University Hospital, Department of Diagnostic Imaging, MolecularImaging, Interventional Radiology and Radiation Therapy, VialeOxford 81, 00133 Rome, Italy. Tel: +39 06 2090 8190, Fax: +39 062090 3692, e-mail: salva.masala@tiscali.itKey Words: Bone metastases, radiofrequency thermal ablation,cementoplasty, breast cancer.ANTICANCER RESEARCH 27: 4259-4262 (2007)Percutaneous Combined Therapy for Painful Sternal Metastases: A Radiofrequency Thermal Ablation (RFTA) and Cementoplasty ProtocolSALVATORE MASALA1, GUGLIELMO MANENTI1, MARIO ROSELLI2, MATTEO MAMMUCARI1, DARIO ALBERTO BARTOLUCCI1, VINCENZO FORMICA2, FRANCESCO MASSARI1 and GIOVANNI SIMONETTI11Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, and2Department of Medical Oncology, "Tor Vergata" University Hospital, Rome, Italy 0250-7005/2007 $2.00+.40to the sternal region was delivered. After 6 weeks, no symptomimprovement was noted and a percutaneous treatment of thelocalised metastasis was proposed. Informed consent was obtained.Before the procedure a repeated CT scan confirmed a 23 mmosteolytic sternal lesion at the 2nd-3rd rib articulation level.RFTA was performed percutaneously under CT guidance. Thepatient was posed in the supine position and the thorax wasprepared and draped in the usual sterile fashion. The lesion wasidentified using the CT pointing system and 1% lidocaine localanesthesia was administered through the skin. A small bladeincision was made and a hand-modified 13-gauge bone biopsyneedle was directed into the sternum. Under CT guidance, theneedle was gently advanced into the lesion. After diagnostic cyto-aspiration, the 15-gauge RFTA needle (MIRAS TX-120, InvatecItalia, Concesio, Italy) was placed through the biopsy needle andthe 3 spiral tines deployed up to 1 cm from the needle sheath(Figure 2). A multi-tine expandable probe was used in order toobtain entire lesion coverage. Correct placement of needle andtines was CT confirmed. Ground pads were placed in thesupraclavear space to avoid the cardiac electrical axis and thenconnected to the electrical circuitation.The procedure was performed with a 40 W energy peak raising thetemperature up to 80ÆC for  3 minutes. A bone lesion RFTAprotocol commonly used for vertebral lesions less than 3 cm indiameter was carried out. The procedure started with a 10 W energyoutput, maintained up to three minutes in order to reduce the localtissue impedence to 50-60 Ohm and then 10 W each further minuteup to a 40 W generator output and 80ÆC homogeneous temperatureat the thermocouple tips. These settings were maintained for about 3minutes, in order to obtain entire lesion coagulative necrosis. In thefirst 120-180 seconds, using such a low energy, it is possible tooptimize radiofrequency flowing at the tissue-electrode interfacewithout charring, distributing radiofrequency homogeneously whilereducing burning pain. The elapsed time for the entire procedure was15-20 minutes.A post-procedure CT scan confirmed the presence of gasbubbles inside the bone lesion, which are commonly interpreted asthe immediate coagulation sign. Gas formation is due tointracellular fluid evaporation after membrane disrupture afterextensive radiofrequency ionizing friction heating. Bubbles areentrapped mainly in the outer soft tissue margins in face toperiosteum burdens.Tines were then retracted and the needle removed from thepatient after a 2 minutes cool-down period.Percutaneous injection of polymethylmethacrylate (PMMA)(~1 cc) for bone stabilization using the biopsy needle as a guide(Figure 3) was subsequently performed.The patient was hospitalized for one night. No complicationoccurred. Antibiotics were administered one day before and threedays after the procedure.ResultsThe procedure was uneventful and patient experienced animmediate pain relief.DiscussionMetastatic cancer is the most common malignant bonedisease. Every year more than a half of the estimated 1.2million new cases of cancer diagnosed in United States willprobably exhibit skeletal metastases (11).Breast, lung and prostate cancer are responsible for morethan 85% of bone metastases (12). The most frequentlyreported symptom of such lesions is pain. It may beexcruciating and so bring about a decrease in the patient’squality of life. Because of the advanced disease at the timeANTICANCER RESEARCH 27: 4259-4262 (2007)4260Figure 1. PT/CT scan of sternal metastasis.Masala et al: A Combined RFTA and Cementoplasty Protocol4261Figure 2. The RF needle has been positioned.Figure 3. A) RF needle with partially deployed tines. B) RF needle positioning using CT control. Only tines are visible (arrow). C) MIP reconstruction:RF needle with deployed tines positioned in the lesion. D) Gas bubbles (arrow) in the upper side of the lesion some minutes after the RFTA procedure.E) Polymethylmethacrylate (PMMA) introduction after RFTA. F) MIP reconstruction: PMMA distribution in the lesion at the end of the procedure.of presentation, current treatments are pain palliation,aimed at preventing treatment complications and reducingthe hospital stay. Radiation therapy, chemotherapy,hormone therapy and analgesic medications are all includedin standard palliation protocols. Currently, radiation therapyis recognized as the most effective treatment, however 20-30% of patients with painful bone metastases are non-responders. Furthermore, patients who have recurrent painin a previously irradiated site may not be suitable for furtherirradiation due to dose limits in normal tissue (7-8).Percutaneous image-guided RFTA uses a high-frequencyalternating current that produces a focal thermal injury totumour cells. RFTA allows the destruction of tumor cellswithout surgical removal and may be used instead of moreinvasive, expensive and complicated techniques, oftenunnecessary for patients with a short life expectancy. Paindecrease is probably due to local sensory terms destructionand cytokines being released as a result of the intense heatof RFTA (13). This technique has been used to treat bothbenign and malignant conditions in several organs. In themusculoskeletal system, it is used to treat osteoid osteomas,chondroblastomas, epithelioid hemangioendotheliomas,chordomas and spinal metastases (9).The integrity of the periosteum is of paramountimportance when RFTA is used for osteolytic bone lesions.After the procedure is completed, thermal ablationcontinues as heat is kept inside the insulating periosteum.In a cool-down period following the retraction of the tines,heat is irradiated from the charring tip producing tissuenecrosis nearby the needle track. This cool-down period,with the energy output off, is variable among the differentbone lesions, mainly depending on cell density and lesiondiameter, as we previously found in swine.To date, RFTA combined with cementoplasty is used onthe spine or other bearing bones with excellent results interms of long-term pain relief (14). RFTA andcementoplasty are mutually enhanced because of thehomogeneous distribution cement of the inside the heatedtissue and the bone burdens.As far as we know, there is no data in the literature onthe use of cementoplasty for sternal lesions. We aimed togive a combined effect of pain relief and bone stabilizationof the osteolytic lesion. RFTA can be performed with nosedation and in patients who would not  be suitable formore invasive surgical procedures because of their age,performance status or disease extension. The mainadvantages of this protocol are the restricted range ofdamage and the immediate pain relief that is reached with asingle-application therapy, while in contrast, RT has to beextended for weeks. In our experience, mechanical orthermal damage to the adjacent organs and structures suchas the pericardium, heart and major vessels were the mostimportant concerns. An accurate and repeated CT scancontrol during needle positioning is the way to guarantee acomplication-free treatment. The position of the groundingpads is another important aspect. In the case reported herethe  supraclavear space was preferred for positioning inorder to avoid electrical flow to the heart area.The RFTA and cementoplasty combined therapy appearsto have a real efficacy against oncological pain and can beconsidered as a true alternative to other palliative therapies.The most important features of this approach are its rapidaction against pain and the limited duration of theprocedure.References1 Mercante S: Malignant bone pain: Pathophysiology andtreatment. Pain 69: 1-18, 1997.2 Hage WD, Aboulafia AJ, Aboulafia DM et al: Incidence,location, and diagnostic evaluation of metastatic bone disease.Orthop Clin North Am 31: 515-528, 2000.3 Nielsen OS, Munro AJ and Tannock IF: Bone metastases:Pathophysiology and management policy. J Clin Oncol 9: 509-524, 1991.4 Janjan N: Bone metastases: approaches and management.Semin Oncol 28: 28-34, 2001.5 Schachar NS: An update on the nonoperative treatment ofpatients with metastatic bone disease. Clin Orthop 328: 75-81,2001.6 Poullsen HS, Nielsen OS, Klee M et al: Palliative radiotherapyin the treatment of skeletal metastasis. Eur J Pain 6: 323-330,1989.7 Gazelle GS, Goldberg SN, Solbiati L et al: Tumor ablation withradio-frequency energy. Radiology 217:633-646, 2000.8 Goetz MP, Callstrom MR, Charboneau JW et al: Percutaneousimage-guided radiofrequency ablation of painful metastasesinvolving bone: a multicentric study. J Clin Oncol 22: 300-306,2004.9 Rosenthal DI, Springfield DS, Gebhardt MC et al: Osteoidosteoma: percutaneous radio-frequency ablation. Radiology197: 451-454, 1995.10 Toyota N, Naito A, Kakizawa H et al: Radiofrequency ablationtherapy combined with cementoplasty for painful bonemetastases: Initial experience. Cardiovasc Intervent Radiol 28:578-583, 2005.11 Stoll BA and Parbhoo S: Bone Metastasis: Monitoring andTreatment, 1st ed., New York: Raven Press, pp. 1-20, 1983.12 Janjan N: Bone metastases: approaches to management. SeminOncol 28: 28-34, 2001.13 Callstrom MR, Charboneau JW, Goetz MP et al: Percutaneousimage-guided raediofrequency ablation of painful metastasesinvolving bone: a multicenter study. J Clin Oncol 22: 300-306,2004.14 Masala S, Roselli M, Massari F et al: Radiofrequency heatablation and vertebroplasty in the treatment of neoplasticvertebral body fractures. Anticancer Res 24: 3129-3133, 2004.Received July 24, 2007Accepted August 6, 2007ANTICANCER RESEARCH 27: 4259-4262 (2007)4262

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Bartolucci, D

Simonetti, Gme

Cineca Institutional Research Information System

https://art.torvergata.it/retrieve/handle/2108/45955/48797/Percutaneous%20combined%20therapy%20for%20painful%20sternal%20metastases.pdf

Percutaneous combined therapy for painful sternal metastases: a radiofrequency thermal ablation (RFTA) and cementoplasty protocol

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