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Jenko N, Henderson RD, Patel AT. Bone lesion cryotherapy: pictorial review and review of current evidence. Br J Radiol 2025; 98:851-860. [PMID: 39814075 DOI: 10.1093/bjr/tqaf007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 12/02/2024] [Accepted: 01/03/2025] [Indexed: 01/18/2025] Open
Abstract
Over the last 2 decades, the development of small probes has enabled percutaneous use of cryotherapy. Cryotherapy, also known as cryoablation, enables the treatment of much larger lesions than other thermal ablation techniques, particularly when using multiple evenly spaced probes. Using rapid cooling to as low as -200°C (at the tip of the probe), reliable, and predictable necrosis can be induced. Probes are usually percutaneously inserted under CT guidance under sedation or general anaesthesia, often as a day case. The procedure is safe with severe complications occurring rarely; the commonest complication is neural injury in lesions closely related to neurovascular bundles. Cryotherapy has been applied to the symptomatic and occasionally curative treatment of bone metastases and a range of primary bone lesions. This review summarizes the published evidence base for the use of cryotherapy in metastatic and primary bone lesions and describes the experience with cryotherapy at the Royal Orthopaedic Hospital, Birmingham, a quaternary bone tumour referral hospital, where cryotherapy has been used for 3 years.
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Affiliation(s)
- Nathan Jenko
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, United Kingdom
| | - Robert D Henderson
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, United Kingdom
| | - Anish T Patel
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, United Kingdom
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Schmidli C, Mosler F, Bower DV, Nöldge G, Heverhagen J, Mertineit N. Computer-navigated, stereotactic navigation for percutaneous radiofrequency ablation of osteoid osteomas: dose comparison and procedure times. BMC Musculoskelet Disord 2025; 26:420. [PMID: 40301871 PMCID: PMC12038928 DOI: 10.1186/s12891-025-08613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 04/02/2025] [Indexed: 05/01/2025] Open
Abstract
PURPOSE Treatment of medication-refractory osteoid osteoma is typically performed with minimally-invasive percutaneous techniques, such as radiofrequency ablation. Given the typically young age of the population of patients being treated, we sought to assess whether using a 3D CT guidance system reduces the number of required probe repositionings and the number of required CTs to validate probe positioning in order to reduce the radiation dosage to the patient. METHODS We retrospectively reviewed the records of 19 patients who underwent procedures at our clinic amounting to a total of 27 ablations between 2012 and 2022. At the time of each procedure, the operating physician made the decision whether or not to use stereotactic navigation assistance. We analyzed the data using a Bayesian approach to elucidate possible differences between procedures conducted with or without navigation. RESULTS Our results showed a statistically and clinically-significant administration of, on average, 200 mGy*cm greater radiation dosage to the patient when stereotactic navigation was used to guide RFA probe placement for ablation of osteoid osteomas compared with not using navigation assistance. There was a trend towards requiring one fewer probe repositioning with navigation assistance, however this was not statistically conclusive. There was no difference in the time required to achieve the target probe placement or in total procedure duration whether stereotactic navigation was used or not. CONCLUSION When utilizing a 3D-guided stereotactic navigation system, there is likely a learning phase before the potential benefits of such a system are realized. Additional radiation administration to the patient may result from the operator learning to properly use and trust the system. In our case, the data also likely reflect a bias in operator choice to use the navigation system when the lesions are more difficult to correctly target or multiple ablation positions are necessary, while choosing conventional imaging assistance for easily targetable tumors, which may conceal some of the benefit of using the navigation system.
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Affiliation(s)
- Chiara Schmidli
- Departement Für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Frank Mosler
- Departement Für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | | | - Gerd Nöldge
- Departement Für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Johannes Heverhagen
- Departement Für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Nando Mertineit
- Departement Für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Institut für Medizinische Radiologie, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
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Thurlow PC, Azhideh A, Ho CK, Stratchko LM, Pooyan A, Alipour E, Hosseini N, Chalian M. Thermal Protection Techniques for Image-guided Musculoskeletal Ablation. Radiographics 2025; 45:e240078. [PMID: 40048387 DOI: 10.1148/rg.240078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2025]
Abstract
Percutaneous image-guided thermal ablation has gained wide acceptance among physicians for the treatment of benign and malignant tumors of the musculoskeletal system. Increasing evidence to support the efficacy of thermal ablation techniques in primary and adjuvant treatment of soft-tissue sarcomas, treatment of oligometastatic disease to bone and soft tissue, and metastatic pain palliation has positioned interventional oncology alongside surgery, systemic therapies, and radiation therapy as the fourth pillar of modern comprehensive cancer care. Despite the expanding indications and increasing use in clinical practice, thermal ablation carries a significant risk of injury to the adjacent vulnerable structures, predominantly the skin, bowel, and neural structures. Knowledge of the mechanism of action of each thermal ablation modality informs the physician of the attendant risks associated with a particular modality. Thermal ablation mechanisms can be divided into hypothermic (cryoablation) and hyperthermic (radiofrequency ablation, microwave ablation, high-intensity focused US, or laser). Active thermal protection techniques include hydrodissection, pneumodissection, direct skin thermal protection, and physical displacement techniques. Passive thermal protection techniques include temperature monitoring, biofeedback, and neurophysiologic monitoring. The authors provide an overview of the mechanism of action of the most commonly used thermal ablation modalities, review the thermal injury risks associated with these modalities, and introduce the active and passive thermal protective techniques critical to safe and effective musculoskeletal ablative therapy. ©RSNA, 2025 See the invited commentary by Tomasian and Jennings in this issue.
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Affiliation(s)
- Peter C Thurlow
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Arash Azhideh
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Corey K Ho
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Lindsay M Stratchko
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Atefe Pooyan
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Ehsan Alipour
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Nastaran Hosseini
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
| | - Majid Chalian
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (P.C.T., A.A., A.P., E.A., N.H., M.C.); Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colo (C.K.H.); and Department of Radiology, Penn State Health, Hershey, Pa (L.M.S.)
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Torabi S, Ahmadzade M, Ghorani H, Sarvari M, Rouientan H, Trinh K, Manzari Tavakoli G, Afsharzadeh M, Uppot RN, Ghasemi-Rad M. Image-guided cryoablation for palliation of painful bone metastases: a systematic review and meta-analysis. Skeletal Radiol 2025:10.1007/s00256-025-04877-7. [PMID: 39890640 DOI: 10.1007/s00256-025-04877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/16/2025] [Accepted: 01/18/2025] [Indexed: 02/03/2025]
Abstract
OBJECTIVE To assess the efficacy of cryoablation in controlling pain from metastatic bone lesions. MATERIALS AND METHODS A systematic search of PubMed, Embase, Scopus, Cochrane library, and Web of Science was conducted from inception to April 2024, focusing on cryoablation for palliation of painful bone metastases. The inclusion criteria were as follows: studies involving patients over 18 years of age who were affected by bone metastases; bone metastases treated with stand-alone cryoablation; studies reporting patients' pain levels before and at least at one time point after cryoablation; and studies published in English. RESULTS A total of 844 articles were initially screened, resulting in 12 articles involving 309 patients included. Pain assessments were conducted at various time points ranging from 1 day to 6 months after the cryoablation procedure. Included studies reported significant improvements in pain scores based on the visual analog scale (VAS), the numeric rating scale (NRS) and brief pain inventory-short form (BPI-SF) following treatment at 1, 4, 8 and 12 weeks. The most notable mean difference between pre- and post-procedure pain scores was observed at 12 weeks, with a standardized mean difference of -3.71 (95% confidence interval [CI]: -5.29 to -2.00; p < 0.001). Regarding pain relief outcomes, by the fourth week, the proportion of patients experiencing pain relief was 0.69 (95% CI: 0.62 to 0.75; p < 0.001). CONCLUSIONS Cryoablation could be an effective method for palliation of painful bone metastases. Further studies are needed to compare its efficacy with other palliative methods and to define its role in cancer management.
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Affiliation(s)
- Sarah Torabi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Sarvari
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kelly Trinh
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gita Manzari Tavakoli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshad Afsharzadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raul Nirmal Uppot
- Department of Radiology, Division of Vascular and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Ghasemi-Rad
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA.
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Michailidis A, Anastasiadi I, Kosmoliaptsis P, George Dimou G, Zlika S, Giankoulof C, Tsifountoudis I, Galanis S, Petsatodis E. Research paper: Two cases of multiple osteoid osteomas in young patients treated with cryoablation: Diagnosis, technical efficacy, and follow-up. Radiol Case Rep 2024; 19:5050-5057. [PMID: 39253044 PMCID: PMC11381857 DOI: 10.1016/j.radcr.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 09/11/2024] Open
Abstract
Osteoid osteomas are benign bone tumors characterized by severe localized pain, often challenging the daily lives of young patients. While these tumors are typically solitary, rare cases of multiple osteoid osteomas have been reported. This research paper presents a case series of 2 young patients with multiple osteoid osteomas, highlighting their clinical presentation, diagnostic workup, treatment with cryoablation, and follow-up. The paper emphasizes the effectiveness of cryoablation as a minimally invasive treatment option for these challenging cases.
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Affiliation(s)
- Antonios Michailidis
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Ilia Anastasiadi
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Kosmoliaptsis
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - G. George Dimou
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Sophia Zlika
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Giankoulof
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Stavros Galanis
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Petsatodis
- Interventional Radiology Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
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Michailidis A, Panos A, Samoladas E, Dimou G, Mingou G, Kosmoliaptsis P, Arvaniti M, Giankoulof C, Petsatodis E. Cryoablation of osteoid osteomas: Is it a valid treatment option? World J Radiol 2024; 16:389-397. [PMID: 39355386 PMCID: PMC11440277 DOI: 10.4329/wjr.v16.i9.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/20/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology. The selected method for its treatment is percutaneous radiofrequency ablation. However, percutaneous cryoablation is an alternative method with certain advantages. AIM To evaluate percutaneous computed tomography (CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. METHODS A total of 25 patients were treated with percutaneous CT- guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution. All patients were above 14-years-old (mean age, 24-years-old), and all procedures were performed under local anesthesia. Of the 25 patients, 8 were female and 17 were male. Tumor sites included the femur (n = 9), medial malleolus (n = 4), sacral ala (n = 4), facets (n = 4), humerus (n = 3), and tibia (n = 1). One cryoprobe was used in each procedure and, when possible, the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus. All necessary thermal protective techniques were used depending on the anatomical structure at risk. RESULTS All patients treated had complete response (100% clinical success rate) starting on the day of the procedure. Technical success was achieved in all cases. Visual analog scale (VAS) scores at 1 year were 0, compared to a mean VAS score of 8.5 ± 1 (SD) before the procedure. No recurrences were reported at the 1-year follow-up and no complications were observed. In 11/25 cases, an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort. All patients were discharged from the hospital on the same day as the procedure. CONCLUSION Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results. Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.
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Affiliation(s)
- Antonios Michailidis
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Athanasios Panos
- Department of 1st Orthopaedic Clinic, Georgios Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Efthimios Samoladas
- Department of 1st Orthopaedic Clinic, Georgios Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Georgios Dimou
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Georgia Mingou
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Panagiotis Kosmoliaptsis
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | | | - Christos Giankoulof
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Evangelos Petsatodis
- Department of Interventional Radiology, Georgios Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
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Mutlu IN, Cingoz M, Guzelbey T, Cingoz E, Kilickesmez O. Percutaneous CT-Guided Microwave Ablation for the Treatment of Osteoid Osteomas: A Single Center Experience. Acad Radiol 2024; 31:3725-3731. [PMID: 38490842 DOI: 10.1016/j.acra.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
RATIONALE AND OBJECTIVES The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). MATERIALS AND METHODS Data from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test. RESULTS 59 patients with an average age of 17.31 ± 8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. CONCLUSION CT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.
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Affiliation(s)
- Ilhan Nahit Mutlu
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
| | - Mehmet Cingoz
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey.
| | - Tevfik Guzelbey
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
| | - Eda Cingoz
- Department of Radiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
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Chan LHD, Chien PYC, Chan THF. A rare cause of shoulder pain: Osteoid osteoma of the scapular glenoid treated with cryoablation. Radiol Case Rep 2024; 19:136-140. [PMID: 37954674 PMCID: PMC10632237 DOI: 10.1016/j.radcr.2023.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
We report a case of an osteoid osteoma at the scapular glenoid that was treated with cryoablation. The patient presented with shoulder pain with subsequent CT and MRI imaging findings suspicious for an osteoid osteoma. The patient complained of persistent pain despite medical treatment and was referred to interventional radiology for consideration of ablation. CT-guided biopsy confirmed the diagnosis of osteoid osteoma and the patient underwent cryoablation of the lesion in the same session. The patient reported a substantial relief in her pain at a follow-up 4 weeks after the procedure. MRI performed 8 weeks after the procedure also confirmed radiographic remission of the lesion.
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Affiliation(s)
- Lok Hei Derek Chan
- Department of Radiology, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong
| | | | - Tommy Ho Fung Chan
- Department of Radiology, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong
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Tsuha Y, Oshiro H, Mizuta K, Aoki Y, Tamaki T, Wada N, Tome Y, Nishida K. Intraoperative cone-beam computed tomography-guided curettage for osteoid osteoma. Medicine (Baltimore) 2023; 102:e36747. [PMID: 38134085 PMCID: PMC10735135 DOI: 10.1097/md.0000000000036747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.
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Affiliation(s)
- Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Pusceddu C, Vergantino E, Santucci D, Marsico S, Cappucci M, Vaccarino F, Beomonte Zobel B, Grasso RF, Faiella E. Percutaneous Cryoablation under Conscious Sedation: A Safe, Effective and Painless Option for the Treatment of Pediatric Osteoid Osteoma. J Clin Med 2023; 12:6889. [PMID: 37959354 PMCID: PMC10650217 DOI: 10.3390/jcm12216889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Percutaneous CT-guided cryoablation is an emerging technique for treating bone tumors. However, experience with using this procedure for osteoid osteomas in pediatric patients remains limited. Our study aims to assess its technical feasibility, clinical efficacy, and safety in children treated under conscious anesthesia. METHODS We conducted a retrospective study of consecutive pediatric patients who underwent CT-guided percutaneous cryoablation for osteoid osteomas at our institution between September 2017 and March 2021. All patients received conscious anesthesia. Data on peri-procedural VAS scores, post-procedural VAS scores, imaging findings, and nonsteroidal anti-inflammatory drug (NSAID) usage rates were collected for each patient. Technical success was defined as proper cryoprobe placement at the nidus center, while clinical success referred to pain relief without NSAID use. Intra- and post-operative complications were also evaluated. RESULTS Nine patients underwent CT-guided percutaneous cryoablation for osteoid osteomas under conscious sedation, with a 100% overall success rate with low peri-procedural and median VAS scores (p < 0.01). No complications were observed during or after the procedure. CONCLUSIONS CT-guided percutaneous cryoablation of pediatric osteoid osteomas is an effective and safe minimally invasive procedure feasible under conscious anesthesia, holding promise as a valuable treatment option.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | - Elva Vergantino
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
| | - Domiziana Santucci
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
| | | | - Matteo Cappucci
- Department of Interventional Radiology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Federica Vaccarino
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
| | - Bruno Beomonte Zobel
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
| | - Rosario Francesco Grasso
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
| | - Eliodoro Faiella
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (E.V.); (B.B.Z.); (R.F.G.); (E.F.)
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11
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Papalexis N, Savarese LG, Peta G, Errani C, Tuzzato G, Spinnato P, Ponti F, Miceli M, Facchini G. The New Ice Age of Musculoskeletal Intervention: Role of Percutaneous Cryoablation in Bone and Soft Tissue Tumors. Curr Oncol 2023; 30:6744-6770. [PMID: 37504355 PMCID: PMC10377811 DOI: 10.3390/curroncol30070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
In the rapidly evolving field of interventional oncology, minimally invasive methods, including CT-guided cryoablation, play an increasingly important role in tumor treatment, notably in bone and soft tissue cancers. Cryoablation works using compressed gas-filled probes to freeze tumor cells to temperatures below -20 °C, exploiting the Joule-Thompson effect. This cooling causes cell destruction by forming intracellular ice crystals and disrupting blood flow through endothelial cell damage, leading to local ischemia and devascularization. Coupling this with CT technology enables precise tumor targeting, preserving healthy surrounding tissues and decreasing postoperative complications. This review reports the most important literature on CT-guided cryoablation's application in musculoskeletal oncology, including sarcoma, bone metastases, and bone and soft tissue benign primary tumors, reporting on the success rate, recurrence rate, complications, and technical aspects to maximize success for cryoablation in the musculoskeletal system.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Leonor Garbin Savarese
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-09, Brazil
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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12
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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13
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Bazzocchi A, Aparisi Gómez MP, Taninokuchi Tomassoni M, Napoli A, Filippiadis D, Guglielmi G. Musculoskeletal oncology and thermal ablation: the current and emerging role of interventional radiology. Skeletal Radiol 2023; 52:447-459. [PMID: 36346453 DOI: 10.1007/s00256-022-04213-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
The role of interventional radiology (IR) is expanding. With new techniques being developed and tested, this radiology subspecialty is taking a step forward in different clinical scenarios, especially in oncology. Musculoskeletal tumoral diseases would definitely benefit from a low-invasive approach that could reduce mortality and morbidity in particular. Thermal ablation through IR has already become important in the palliation and consolidation of bone metastases, oligometastatic disease, local recurrences, and treating specific benign tumors, with a more tailored approach, considering the characteristics of every patient. As image-guided ablation techniques lower their invasiveness and increase their efficacy while the collateral effects and complications decrease, they become more relevant and need to be considered in patient care pathways and clinical management, to improve outcomes. We present a literature review of the different percutaneous and non-invasive image-guided thermal ablation methods that are currently available and that could in the future become relevant to manage musculoskeletal oncologic diseases.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | - Makoto Taninokuchi Tomassoni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Dimitrios Filippiadis
- 2nd Radiology Department, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, Athens, Greece
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
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14
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Tomasian A, Cazzato RL, Sharma K, Gangi A, Jennings JW. Benign Bone Tumors: State of the Art in Minimally Invasive Percutaneous Interventions. Radiographics 2023; 43:e220041. [PMID: 36563097 DOI: 10.1148/rg.220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Painful benign bone tumors most commonly affect pediatric patients and young adults. They may be associated with skeletal-related events such as intractable pain, pathologic fracture, neurologic deficit as a consequence of nerve or spinal cord compression, as well as growth disturbance. Consequently, they often result in diminished activity and adversely affect quality of life. There have been substantial recent advances in percutaneous minimally invasive image-guided interventions for treatment of painful benign bone tumors including thermal ablation (radiofrequency ablation, cryoablation, microwave ablation, laser photocoagulation, and high-intensity focused US ablation), chemical (alcohol) ablation, cementoplasty, and intralesional injections. The safety, efficacy, and durability of such interventions have been established in the recent literature and as such, the role of musculoskeletal interventional radiologists in the care of patients with benign bone lesions has substantially expanded. The treatment goal of minimally invasive musculoskeletal interventions in patients with benign bone tumors is to achieve definitive cure. The authors detail the most recent advances and available armamentarium in minimally invasive image-guided percutaneous interventions with curative intent for the management of benign bone tumors. © RSNA, 2022.
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Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Roberto Luigi Cazzato
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Karun Sharma
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Afshin Gangi
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
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15
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Kammoun T, Prévot E, Serrand C, Perolat R, de Forges H, Houédé N, Beregi JP, Frandon J. Feasibility and Safety of Single-Probe Cryoablation with Liquid Nitrogen: An Initial Experience in 24 Various Tumor Lesions. Cancers (Basel) 2022; 14:cancers14215432. [PMID: 36358850 PMCID: PMC9655210 DOI: 10.3390/cancers14215432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Percutaneous cryoablation was developed to minimally perform multi-organ tumor ablations. The most widely known cryotherapy systems use argon gas (high-pressure) and multiple needles to achieve sufficient ablations. The aim of our retrospective study was to assess the feasibility of a new cryotherapy system using single-probe liquid nitrogen for tumor lesions of various sizes and locations, and to evaluate the safety of cryoablation with this technique. Correlations between ice ball sizes and ablation zone sizes with two needle sizes (10G or 13G) and with the freezing duration were evaluated, as well as the sphericity of the ice ball and ablation zones. We showed that this technique is safe in all organs tested. We showed a correlation between the freezing duration and the ice ball size, but not with the ablation zone, which is useful for planning the procedure and treatment conducted by the oncology team. Abstract Background: Percutaneous cryoablation with liquid nitrogen is a new technique being used in the treatment of some malignant tumors. Our objective was to assess its feasibility in the ablation of tumor lesions of various sizes and locations. Methods: This retrospective, monocentric study included all consecutive patients who underwent percutaneous cryoablation with liquid nitrogen between December 2019 and March 2021. Cryoablation was performed using 10G or 13G cryoprobes. The ablation volume was measured on post-treatment CT or MRI. Results: 22 patients (24 lesions) were included, 16 of whom were men (73%), while median age was 66 years. The lesions were located in the bone (42%), kidney (29%), soft tissue (17%), lung (8%), or liver (4%). It was feasible in all tumor locations and produced median ablation zones 25 mm in width and 35 mm in length, with a 23 min median freezing time. Freezing duration was correlated with the ice volume (p Spearman = 0.02), but not with the ablation volume (p = 0.11). The average difference between the ablation zone and ice ball sizes were −6.4 mm in width and −7.7 mm in length. Both ice and ablation volumes were larger when using the 10G probe as compared to when the 13G was used. No complications were reported. Discussion: We showed that this technique was safe and feasible in all organs tested. The freezing duration was correlated with the ice ball size, but not with the ablation zone.
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Affiliation(s)
- Tarek Kammoun
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Elodie Prévot
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nimes, 30029 Nimes, France
| | - Romain Perolat
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Hélène de Forges
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Nadine Houédé
- Gard Cancer Institute, Nimes University Hospital, University of Montpellier, 30029 Nimes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Julien Frandon
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
- Correspondence:
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16
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Shu M, Ke J. The surgical management of osteoid osteoma: A systematic review. Front Oncol 2022; 12:935640. [PMID: 35936708 PMCID: PMC9355277 DOI: 10.3389/fonc.2022.935640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Osteoid osteoma (OO) comprises approximately 11%-14% of benign bone tumors. The main symptom of OO is localized pain accompanied by nighttime aggravation. Surgical treatment is frequently used in clinic, including open surgery and percutaneous ablation, the latter including radiofrequency ablation, cryoablation, and microwave ablation, but there is no consensus on when and how to choose the best treatment for OO. Purpose We did a systematic review of the literature on existing surgical treatments of OO to assess the safety and efficacy of surgical treatments of OO and to evaluate the surgical options for different locations of OO. Methods The inclusion criteria in the literature are 1. Patients diagnosed with osteoid osteoma and treated surgically; 2. Include at least five patients; 3. Perioperative visual analogue scale (VAS), postoperative complications, and recurrence were recorded; 4. Literature available in PubMed from January 2014 to December 2021. Results In the cohort, 1565 patients (mainly adolescents) with OO received 1615 treatments. And there are 70 patients with postoperative recurrence and 93 patients with postoperative complications (minor: major=84:9). The results of Kruskal-Wallis examination of each experimental index in this experiment were clinical success rate H=14.818, p=0.002, postoperative short-term VAS score H=212.858, p<0.001, postoperative long-term VAS score H=122.290, p<0.001, complication rate H=102.799, p<0.001, recurrence rate H=17.655, p<0.001, the technical success rate was H=45.708, p<0.001, according to the test criteria of α=0.05, H0 was rejected. The overall means of the outcome index in each group were not completely equal. Conclusion Percutaneous ablation and open surgery are safe and reliable for OOs, and the technical success rate of percutaneous ablation is higher than that of open surgery. Open surgery and cryoablation can be selected for OOs close to the nerve and atypical sites, while radiofrequency ablation and microwave ablation can be selected for OOs in most other sites.
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Affiliation(s)
- Man Shu
- Department of Orthopaedics, General Hospital of Southern Theater Command, Southern Medical University, Guangzhou, China
| | - Jin Ke
- Department of Orthopaedics, ZhuJiang Hospital of Southern Medical University, Southern Medical University, Guangzhou, China
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17
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Ni X, Zhang Z, Xu P, Ning B, Wang D. Intra- and juxta-articular osteoid osteoma in children and adolescents. Transl Pediatr 2022; 11:1105-1113. [PMID: 35958008 PMCID: PMC9360828 DOI: 10.21037/tp-21-612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Osteoid osteoma (OO) is a common benign tumor in children and adolescents, but intra-and juxta-articular OO is rare and difficult to diagnose. The purpose of this study is to investigate the distinctions between intra- and juxta-articular OO, trying to avoid delaying diagnosis and optimize treatment strategies. METHODS Thirty patients diagnosed with OO in the intra- and juxta joint at our institution who underwent surgical resection were included. Clinical and epidemiological factors, preoperative radiograph parameters, including computed tomography (CT), magnetic resonance imaging (MRI), and bone scan, were documented. The outcomes of the involved extremity were evaluated at the final follow-up. RESULTS Mean age at diagnosis, interval time, and follow-up time was 8.37±3.79 years old, 4.67±5.88 months, 3.57±2.18 years, respectively. Factors identified to be significantly associated with intra- and juxta-articular OO including pain with activity (P=0.004) and abnormal range of motion (P=0.00). The factor of abnormal range of motion (P=0.03) also influenced the existence of complications. Six children had a secondary operation to cure the recurrence. CONCLUSIONS It is essential for clinicians and radiologists to be aware of the atypical clinical and radiographic features of intra- and juxta-articular OO, as the delayed diagnosis can lead to unnecessary pain and further complications after surgeries. The pain with activity and abnormal range of motion is helpful to identify the location of OO. The persistently abnormal range of motion also significantly leads to complications. The open surgeries to resect the nidus in juxta-articular OO were effective.
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Affiliation(s)
- Xiaoyan Ni
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China
| | - Zhiqiang Zhang
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China
| | - Ping Xu
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China
| | - Bo Ning
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China
| | - Dahui Wang
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China
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18
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Zeng H, He H, Tong X, Wang Z, Luo R, Liu Q. Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection. Front Surg 2022; 9:922317. [PMID: 35836603 PMCID: PMC9273932 DOI: 10.3389/fsurg.2022.922317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Proximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO. Methods This was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months. Results We followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare. Conclusion Open surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.
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Affiliation(s)
- Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Xiaopeng Tong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiwei Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Rongsheng Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
- Correspondence: Qing Liu ;
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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CIRSE Standards of Practice on Thermal Ablation of Bone Tumours. Cardiovasc Intervent Radiol 2022; 45:591-605. [PMID: 35348870 PMCID: PMC9018647 DOI: 10.1007/s00270-022-03126-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/28/2022] [Indexed: 02/03/2023]
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.
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Sagoo NS, Haider AS, Chen AL, Vannabouathong C, Larsen K, Sharma R, Palmisciano P, Alamer OB, Igbinigie M, Wells DB, Aoun SG, Passias PG, Vira S. Radiofrequency ablation for spinal osteoid osteoma: A systematic review of safety and treatment outcomes. Surg Oncol 2022; 41:101747. [PMID: 35358911 DOI: 10.1016/j.suronc.2022.101747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
AIM We sought to systematically assess and summarize the available literature on the clinical outcomes and complications following radiofrequency ablation (RFA) for painful spinal osteoid osteoma (OO). METHODS PubMed, Scopus, and CENTRAL databases were searched in accordance with PRISMA guidelines. Studies with available data on safety and clinical outcomes following RFA for spinal OO were included. RESULTS In the 14 included studies (11 retrospective; 3 prospective), 354 patients underwent RFA for spinal OO. The mean ages ranged from 16.4 to 28 years (Females = 31.3%). Lesion diameters ranged between 3 and 20 mm and were frequently seen in the posterior elements in 211/331 (64%) patients. The mean distance between OO lesions and neural elements ranged between 1.7 and 7.4 mm. The estimated pain reduction on the numerical rating scale was 6.85/10 (95% confidence intervals [95%CI] 4.67-9.04) at a 12-24-month follow-up; and 7.29/10 (95% CI 6.67-7.91) at a >24-month follow-up (range 24-55 months). Protective measures (e.g., epidural air insufflation or neuroprotective sterile water infusion) were used in 43/354 (12.1%) patients. Local tumor progression was seen in 23/354 (6.5%) patients who were then successfully re-treated with RFA or open surgical resection. Grade I-II complications such as temporary limb paresthesia and wound dehiscence were reported in 4/354 (1.1%) patients. No Grade III-V complications were reported. CONCLUSION RFA demonstrated safety and clinical efficacy in most patients harboring painful spinal OO lesions. However, further prospective studies evaluating these outcomes are warranted.
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Affiliation(s)
- Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Bryan, TX, USA
| | - Andrew L Chen
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | | | - Kylan Larsen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ruhi Sharma
- Ross University School of Medicine, Miramar, FL, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Othman Bin Alamer
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Matthew Igbinigie
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Bianchi G, Zugaro L, Palumbo P, Candelari R, Paci E, Floridi C, Giovagnoni A. Interventional Radiology’s Osteoid Osteoma Management: Percutaneous Thermal Ablation. J Clin Med 2022; 11:jcm11030723. [PMID: 35160184 PMCID: PMC8836989 DOI: 10.3390/jcm11030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/27/2023] Open
Abstract
Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate.
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Affiliation(s)
- Giampaolo Bianchi
- Diagnostic and Interventional Radiology, SS. Filippo e Nicola Hospital, 67051 Avezzano, Italy
- Correspondence:
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (L.Z.); (P.P.)
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (L.Z.); (P.P.)
| | - Roberto Candelari
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, 60100 Ancona, Italy; (R.C.); (E.P.)
| | - Enrico Paci
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, 60100 Ancona, Italy; (R.C.); (E.P.)
| | - Chiara Floridi
- Department of Radiology, University Hospital “Umberto I-Lancisi-Salesi”, 60100 Ancona, Italy;
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Ospedali Riuniti, Marche Polytechnic University, 60100 Ancona, Italy;
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Le Corroller T, Vives T, Mattei JC, Pauly V, Guenoun D, Rochwerger A, Champsaur P. Osteoid Osteoma: Percutaneous CT-guided Cryoablation Is a Safe, Effective, and Durable Treatment Option in Adults. Radiology 2021; 302:392-399. [PMID: 34812672 DOI: 10.1148/radiol.2021211100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.
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Affiliation(s)
- Thomas Le Corroller
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Thomas Vives
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Jean-Camille Mattei
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Vanessa Pauly
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Daphné Guenoun
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Alexandre Rochwerger
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Pierre Champsaur
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
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Moreno Romero M, Pérez Muñoz I, González Lizán F, Gallego Rivera J, Valdivielso Cañas L. The phosphaturic mesenchymal tumor as a cause of oncogenic osteomalacia. Three cases and review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A, Tepelenis N, Varvarousis D, Vlachos K, Kanavaros P, Kitsoulis P. Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option. In Vivo 2021; 35:1929-1938. [PMID: 34182465 DOI: 10.21873/invivo.12459] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
Osteoid osteoma, the third most common benign bone tumor, usually occurs in the cortex of long bones. It consists of a radiolucent nidus surrounded by reactive osteosclerosis. Generally, osteoid osteoma affects young males. Nocturnal pain that eases with salicylates or nonsteroidal anti-inflammatory drugs (NSAID) is the typical clinical presentation. Sometimes, it remains undiagnosed for a long time. Plain radiography and computed tomography are usually sufficient for the diagnosis of osteoid osteoma. Initial treatment includes salicylates and NSAID because the tumor often regresses spontaneously over 2-6 years. Surgical treatment is indicated in case of unresponsive pain to medical therapy, no tolerance of prolonged NSAID therapy due to side effects, and no willingness to activity limitations. Nowadays, minimally invasive techniques have replaced open surgery and are considered the gold standard of surgical treatment. Although cryoablation seems superior in terms of the nerve damage and immunotherapy effect, radiofrequency ablation is the preferred technique.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | - Georgios P Skandalakis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, U.S.A
| | | | | | | | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
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Cazzato RL, de Rubeis G, de Marini P, Dalili D, Koch G, Auloge P, Garnon J, Gangi A. Percutaneous microwave ablation of bone tumors: a systematic review. Eur Radiol 2021; 31:3530-3541. [PMID: 33155107 DOI: 10.1007/s00330-020-07382-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
AIM To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors. MATERIALS AND METHODS A systematic literature search was conducted using PubMed, the Cochrane Library, EMBASE, and Web of Science database. Data concerning patient demographics, tumor characteristics, procedure, complications, and clinical outcomes were extracted and analyzed. RESULTS Seven non-comparative studies (6 retrospective, 1 prospective) were included accounting for 249 patients and 306 tumors (244/306 [79.7%] metastases; 25/306 [8.2%] myelomas, and 37/306 [12.1%] osteoid osteomas [OO]). In malignant tumors, MWA power was 30-70 W (except in one spinal tumors series where a mean power of 13.3 W was used) with pooled mean ablation time of 308.3 s. With OO, MWA power was 30-60 W with mean ablation time of 90-102 s. Protective measures were very sporadically used in 5 studies. Additional osteoplasty was performed in 199/269 (74.0%) malignant tumors. Clinically significant complications were noted in 10/249 (4.0%) patients. For malignant tumors, estimated pain reduction on the numerical rating scale was 5.3/10 (95% confidence intervals [95%CI] 4.6-6.1) at 1 month; and 5.3/10 (95% CI 4.3-6.3) at the last recorded follow-up (range 20-24 weeks in 4/5 studies). For OO, at 1-month follow-up, effective pain relief was noted in 92.3-100% of patients. CONCLUSION MWA is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful OO and malignant bone tumors, respectively. Although MWA seems safe, further prospective studies are warranted to further assess this aspect, and to standardize MWA protocols. KEY POINTS • Large heterogeneity exists across literature about ablation protocols used with microwave ablation applied for the treatment of benign and malignant bone tumors. • Although microwave ablation of bone tumors appears safe, further studies are needed to assess this aspect, as current literature does not allow definitive conclusions. • Nevertheless, microwave ablation is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful osteoid osteomas and malignant bone tumors, respectively.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France.
| | - Gianluca de Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
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Moreno Romero M, Pérez Muñoz I, González Lizán F, Gallego Rivera JI, Valdivielso Cañas L. The phosphaturic mesenchymal tumor as a cause of oncogenic osteomalacia. Three cases and review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00050-3. [PMID: 33903024 DOI: 10.1016/j.recot.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The phosphaturic mesenchymal tumour (PMT) is a very uncommon cause of oncogenic osteomalacia (OO), which is a paraneoplastic syndrome with severe clinical osteomalacia. The PMT is a neoplasia that produces the fibroblast growth factor FGF23, resulting in reduced proximal tubular phosphate reabsorption leading to hyperphosphaturia and hypophosphatemia. Our aim is to present our experience and complications in diagnosis and treatment of PMT in three patients. MATERIAL AND METHODS We propose an observational, descriptive and retrospective study of three cases of OO secondary to PMT found in our database of bone and soft tissue tumours. The inclusion criteria were: symptoms related with OO, presence of hyperphosphaturic hypophosphatemia, elevated levels of FGF23 in blood and pathological diagnosis of PMT. RESULTS In all cases, the disease showed asthenia, non-specific bone pain, progressive functional weakness, and pathological fractures. The average delay time in diagnosis was 7 years. All presented with hyperphosphaturic hypophosphatemia, elevated levels of alkaline phosphatase as well as FGF23. The use of Octreoscan and PET-CT were essential to find the producing tumour and its subsequent biopsy. Treatment was surgery in two cases and one case was treated by CT-guided cryotherapy with neurophysiological control. Once the surgery was performed, the blood parameters normalized. There is no recurrence. CONCLUSIONS Phosphaturic mesenchymal tumor is a very rare entity as part of bone and soft tissue tumors, it may occur in both tissues. The phosphate-calcium homeostasis is altered due to high serum levels of FGF23 because of PMT. Delay in diagnosis is usual, leading to renal and skeletal comorbidities. To avoid this, knowledge of this entity together with high diagnostic suspicion are critical. Surgical treatment leads to normalization of serum levels and systemic symptoms.
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Affiliation(s)
- M Moreno Romero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Ramón y Cajal, Madrid, España.
| | - I Pérez Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Ramón y Cajal, Madrid, España
| | - F González Lizán
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Ramón y Cajal, Madrid, España
| | | | - L Valdivielso Cañas
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
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Parmeggiani A, Martella C, Ceccarelli L, Miceli M, Spinnato P, Facchini G. Osteoid osteoma: which is the best mininvasive treatment option? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1611-1624. [PMID: 33839926 PMCID: PMC8578134 DOI: 10.1007/s00590-021-02946-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/21/2021] [Indexed: 01/21/2023]
Abstract
Osteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation's advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.
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Affiliation(s)
- Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy.
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy.,U.O. Di Radiologia, Ospedale degli Infermi, Azienda AUSL Della Romagna, Faenza, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
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Scandiffio R, Bozzi E, Ezeldin M, Capanna R, Ceccoli M, Colangeli S, Donati DM, Colangeli M. Image-guided Cryotherapy for Musculoskeletal Tumors. Curr Med Imaging 2021; 17:166-178. [PMID: 32842945 DOI: 10.2174/1573405616666200825162712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This article represents a review of the use of image-guided cryotherapy in the treatment of musculoskeletal tumor lesions. Cryotherapy is able to induce a lethal effect on cancer cells through direct and indirect mechanisms. In this manuscript, we combined our experience with that of other authors who have published on this topic in order to provide indications on when to use cryotherapy in musculoskeletal oncology. DISCUSSION Image-Guided percutaneous cryotherapy is a therapeutic method now widely accepted in the treatment of patients with musculoskeletal tumors. It can be used both for palliative treatments of metastatic bone lesions and for the curative treatment of benign bone tumors, such as osteoid osteoma or osteoblastoma. In the treatment of bone metastases, cryotherapy plays a major role in alleviating or resolving disease-related pain, but it has also been demonstrated that it can have a role in local disease control. In recent years, the use of cryotherapy has also expanded for the treatment of both benign and malignant soft tissue tumors. CONCLUSION Percutaneous cryotherapy can be considered a safe and effective technique in the treatment of benign and malignant musculoskeletal tumors. Cryotherapy can be considered the first option in benign tumor lesions, such as osteoid osteoma, and a valid alternative to radiofrequency ablation. In the treatment of painful bone metastases, it must be considered secondarily to other standard treatments (radiotherapy, bisphosphonate therapy, and chemotherapy) when they are no longer effective in controlling the disease or when they cannot be repeated (for example, radiotherapy).
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Affiliation(s)
- Rossella Scandiffio
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Mohamed Ezeldin
- Department of Diagnostic and Interventional Radiology, Sohag University Hospital, Sohag, Egypt
| | - Rodolfo Capanna
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ceccoli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide M Donati
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Colangeli
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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Shanmugasundaram S, Nadkarni S, Kumar A, Shukla PA. Percutaneous Ablative Therapies for the Management of Osteoid Osteomas: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2021; 44:739-749. [PMID: 33709278 DOI: 10.1007/s00270-021-02804-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate safety and efficacy of percutaneous ablative therapy for the treatment for osteoid osteomas. MATERIALS AND METHODS PubMed database, Web of Science, and SCOPUS were searched from their inception until November 2019 for articles describing osteoid osteoma. Demographic data, success rates, pre- and post-procedure VAS scores, and complications were recorded. A random-effects meta-analyses of the VAS pain score at various time points were calculated. RESULTS For radiofrequency ablation, VAS scores for pain at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 7.64 +/- 0.175, 0.78 +/- 0.186, and 0.02 +/- 0.0196, respectively. For cryoablation, VAS scores at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 8.46 +/- 0.549, 0.975 +/- 0.66, and 0.112 +/- 0.08, respectively. For laser ablation, VAS scores at pre-procedure and 24-48 h yielded cumulative pain scores of 4.94 +/- 1.42, and 0.506 +/- 0.268, respectively. For microwave ablation, VAS scores at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 6.14 +/- 1.07, 1.636 +/- 1.215, and 0 +/- 0.0, respectively. All ablation methods resulted in significant immediate and lasting pain reduction (p < 0.001). Technical and clinical success rates and major complications for RFA, microwave ablation, laser ablation, and cryoablation did not differ significantly. Overall recurrence of bone pain at the same site occurred in 4.06% of all patients an average of 11 months post-procedure. CONCLUSION Percutaneous ablative therapies are safe and result in significant and lasting pain reduction as demonstrated through visual analog scale pain scores.
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Affiliation(s)
- Srinidhi Shanmugasundaram
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ, 07103, USA
| | - Shree Nadkarni
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ, 07103, USA
| | - Abhishek Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ, 07103, USA
| | - Pratik A Shukla
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ, 07103, USA.
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Meng L, Zhang X, Xu R, Wu B, Zhang X, Wei Y, Li J, Shan H, Xiao Y. A preliminary comparative study of percutaneous CT-guided cryoablation with surgical resection for osteoid osteoma. PeerJ 2021; 9:e10724. [PMID: 33520471 PMCID: PMC7812921 DOI: 10.7717/peerj.10724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
Background The traditional treatment for osteoid osteoma is the nidus’ surgical resection, which was difficult to eradicate with more invasive and complications because of osteosclerosis surrounding the nidus. This study aimed to analyze the efficacy and safety of percutaneous CT-guided cryoablation of osteoid osteoma at different sites (especially refractory sites such as the spine). Methods Fifteen patients with osteoid osteoma who underwent cryoablation at our institution were analyzed retrospectively on their imaging data and clinical visual analog scale (VAS) pain scores before and after the procedure. Fifty-three patients underwent surgical resection during the period were also included in this study as a control group. Treatment efficacy was assessed primarily by comparing the differences in VAS scores at different time points in each group of patients by paired-sample t-test. Differences in length of hospital stay and complications between the two groups were also compared. Results The technical success rate was 100% in both the cryoablation and surgical resection group. Cryoablation had a significantly shorter hospitalization time than surgery (p = 0.001). Clinically, the post-operative VAS scores were all significantly improved compared to the pre-operative period, and the clinical cure was achieved in both groups. Surgical operations had more complications than cryoablation, although there was no significant difference. In the group of cryoablation, only one patient had mild numbness of the left lower extremity, which relieved itself; two patients had mild post-operative pain. No patients in the cryoablation group experienced recurrence during the follow-up period. In the surgery group, three of the patients experienced massive bleeding (>500 ml), and two underwent transfusion therapy. Only one patient in the surgical resection group experienced a recurrence at 29 months postoperatively and underwent a second resection. All patients had local scars on the skin after surgical resection. Conclusion Cryoablation is a minimally invasive, safe, and effective treatment strategy for osteoid osteoma, and is fully comparable to surgical resection.
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Affiliation(s)
- Liangliang Meng
- Medical School of Chinese PLA, Beijing, China.,Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruijiang Xu
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bin Wu
- Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiaobo Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingtian Wei
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Husheng Shan
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
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Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Tomasian A, Cazzato R, Auloge P, Garnon J, Gangi A, Jennings J. Osteoid osteoma in older adults: clinical success rate of percutaneous image-guided thermal ablation. Clin Radiol 2020; 75:713.e11-713.e16. [DOI: 10.1016/j.crad.2020.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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Lindquester WS, Crowley J, Hawkins CM. Percutaneous thermal ablation for treatment of osteoid osteoma: a systematic review and analysis. Skeletal Radiol 2020; 49:1403-1411. [PMID: 32270226 DOI: 10.1007/s00256-020-03435-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although radiofrequency ablation is well validated for treatment of osteoid osteoma, newer technologies, namely cryoablation, have been less thoroughly studied. The purpose is to perform a systematic review and pooled analysis of percutaneous ablation technologies for treatment of osteoid osteoma with subset analysis of intra-articular and spinal tumors. MATERIAL AND METHODS A total of 36 of 79 identified manuscripts met inclusion criteria, comprising 1863 ablations in 1798 patients. Inclusion criteria were (1) retrospective or prospective analysis of thermal ablation of osteoid osteomas in any location, (2) at least 6 months of clinical follow-up, (3) 10 or more patients, (4) patients not included in a second study included in this review, and (5) English language or English translation available. Success rate was defined as all ablations minus technical failures, clinical failures, and recurrences. Subset analysis of intra-articular and spinal tumors was performed. RESULTS Overall success rate was 91.9% (95% CI 91-93%). Technical failure, clinical failure, and recurrence rates were 0.3%, 2.1%, and 5.6% respectively. Complications were seen in 2.5% (95% CI 1.9-3.3%) patients. There was no significant difference when comparing radiofrequency ablation and cryoablation (p = 0.92). Success rates for intra-articular (radiofrequency ablation) and spinal tumors (radiofrequency and cryoablation) were 97% and 91.6% respectively. CONCLUSION Percutaneous ablation of osteoid osteomas was highly successful with low complication rates. Efficacy of radiofrequency ablation and cryoablation is similar, which is consequential because cryoablation is associated with decreased pain, predictable nerve regeneration, and theoretical immunotherapy benefits. Treatment of more challenging intra-articular and spinal lesions demonstrated similarly high success and low complication rates.
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Affiliation(s)
- Will S Lindquester
- Department of Radiology, Univeristy of Pittsburgh Medical Center, Presbyterian University Hospital, Suite E204 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - John Crowley
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Radiology Department, 2nd Floor, Pittsburgh, PA, 15224, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 100 Woodruff Circle, Atlanta, GA, USA
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Percutaneous cryoablation of osteoblastoma in the proximal femur. Skeletal Radiol 2020; 49:1467-1471. [PMID: 32166366 DOI: 10.1007/s00256-020-03413-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023]
Abstract
A 37-year-old man presented with a 2-year history of left hip pain. Pretherapeutic imaging demonstrated a 4 cm osteoblastoma located in the intertrochanteric region of the proximal femur, surrounded by extensive bone marrow edema. After multidisciplinary meeting, percutaneous cryoablation was decided and performed under computed tomography guidance using three cryoprobes to match the exact size and shape of the tumor, resulting in complete resolution of symptoms. Magnetic resonance imaging follow-up demonstrated resolution of the bone marrow edema pattern and ingrowth of fat at the periphery of the ablation zone consistent with long-term healing of the tumor.
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Yang Y, Li Y, Wu Y, Qiu S, Liu C, Wang Q, Hong Y, Lyu J, Zhang Y, Du D. Retrospective analysis of CT-guided percutaneous cryoablation for treatment of painful osteolytic bone metastasis. Cryobiology 2020; 92:203-207. [PMID: 31958427 DOI: 10.1016/j.cryobiol.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/10/2023]
Abstract
This study aimed to evaluate the safety and effectiveness of CT-guided percutaneous cryoablation for treatment of painful osteolytic bone metastases. A total of 26 patients (36 bone metastases) treated with CT-guided percutaneous cryoablation between May 2012 and June 2016 were enrolled in this retrospective study. All procedures were performed under local anesthesia. A visual analog scale (VAS) was used to evaluate pain before the procedure and at 1 day, 1 month, 3 months, and 6 months after the procedure. Complications during and after the procedure were recorded and graded by the Clavien-Dindo classification. The mean VAS pain score was 7.1 ± 1.1 (range, 4-10) before cryoablation. It was significantly lower at all timepoints after treatment: 2.1 ± 1.7 (P < 0.0001) at 1 day after treatment, 1.3 ± 1.8 (P < 0.0001) at 1 month, 1.6 ± 1.7 (P < 0.0001) at 3 months, and 1.8 ± 1.3 (P < 0.0001) at 6 months. The response rates were 91.7%, 94.4%, 91.7%, and 94.4%, respectively, at 1 day, 1 month, 3 months, and 6 months after cryoablation; the complete response rates were 22.2%, 41.7%, 36.1%, and 22.2%, respectively. Adverse events (skin frostbite, nerve injury, pathologic fracture) occurred in 3 patients. CT-guided percutaneous cryoablation under local anesthesia appears to be a safe and effective treatment for painful osteolytic bone metastases. Prospective clinical trials on large samples needed to confirm this conclusion.
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Affiliation(s)
- Yumei Yang
- Department of Ultrasound, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000, China
| | - Yong Li
- Department of Interventional Radiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Yumin Wu
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Shuibo Qiu
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Chunlin Liu
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Qiuyu Wang
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Yuefei Hong
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Jialing Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, 518020, China.
| | - Duanming Du
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
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O'Dell MC, Vatsky S. Percutaneous Treatment of Musculoskeletal Disease in Children. Semin Roentgenol 2019; 54:384-394. [PMID: 31706371 DOI: 10.1053/j.ro.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Cody O'Dell
- Department of Radiology, AdventHealth Orlando, Orlando, FL.
| | - Seth Vatsky
- Perelman School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
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Auloge P, Cazzato RL, Rousseau C, Caudrelier J, Koch G, Rao P, Chiang JB, Garnon J, Gangi A. Complications of Percutaneous Bone Tumor Cryoablation: A 10-year Experience. Radiology 2019; 291:521-528. [PMID: 30806603 DOI: 10.1148/radiol.2019181262] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Percutaneous cryoablation has been shown to be effective in the management of painful bone tumors. However, knowledge of the complication rate and risk factors for complication is currently lacking. Purpose To report the complication rate and associated risk factors for bone tumor cryoablation. Materials and Methods This retrospective study reviewed complications in 239 consecutive patients (131 men and 108 women; median age, 64 years; age range, 6-86 years) who underwent cryoablation of 320 primary or metastatic bone tumors between January 2008 and November 2017. Common Terminology Criteria for Adverse Events was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Multivariable analysis was performed for variables with P values less than .20, including age, tumor location, adjacent critical structures, number of cryoprobes, and Eastern Cooperative Oncology Group performance status (ECOG-PS). Results Among the 320 tumors, the total complication rate was 9.1% (29 of 320; 95% confidence interval [CI]: 6%, 12.2%). The major complication rate was 2.5% (eight of 320; 95% CI: 0.8%, 4.2%), with secondary fracture the most frequent complication (1.2% [four of 320]; mean delay, 71 days); cryoablation site infection, tumor seeding, bleeding, and severe hypotension were each observed in 0.3% (one of 320) of procedures. Minor complications included postprocedural pain (2.2% [seven of 320]), peripheral neuropathy (0.9% [three of 320]), and temporary paresthesia (0.9% [three of 320]). For all complications, associated risk factors included ECOG-PS greater than 2 (odds ratio [OR], 3.1 [95% CI: 3, 7.6]; P = .01), long-bone cryoablation (OR, 17.8 [95% CI: 2.3, 136.3]; P = .01), and use of more than three cryoprobes (OR, 2.5 [95% CI: 1.0, 6.0]; P = .04); for major complications, associated risk factors included age greater than 70 years (OR, 7.1 [95% CI: 1.6, 31.7]; P = .01) and use of more than three cryoprobes (OR, 23.6 [95% CI: 2.8, 199.0]; P = .01). Conclusion Bone tumor cryoablation is safe, with a 2.5% rate of major complications, most commonly secondary fracture (1.2%). Major complications are associated with age greater than 70 years and use of more than three cryoprobes. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Jennings in this issue.
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Affiliation(s)
- Pierre Auloge
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Roberto L Cazzato
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Chloé Rousseau
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Jean Caudrelier
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Guillaume Koch
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Pramod Rao
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Jeanie Betsy Chiang
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Julien Garnon
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Afshin Gangi
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
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Noordin S, Allana S, Hilal K, Nadeem N, Lakdawala R, Sadruddin A, Uddin N. Osteoid osteoma: Contemporary management. Orthop Rev (Pavia) 2018; 10:7496. [PMID: 30370032 PMCID: PMC6187004 DOI: 10.4081/or.2018.7496] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022] Open
Abstract
Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection.
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Affiliation(s)
| | - Salim Allana
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Naila Nadeem
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Riaz Lakdawala
- Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - Anum Sadruddin
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nasir Uddin
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Phase I clinical trial of percutaneous cryoablation for osteoid osteoma. Jpn J Radiol 2018; 36:669-675. [PMID: 30109554 DOI: 10.1007/s11604-018-0768-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This prospective phase I trial was conducted to evaluate the safety of percutaneous cryoablation for osteoid osteoma (OO). MATERIALS AND METHODS Nine patients with OO (mean tumor size: 5.9 mm; tibia, n = 5; femur, n = 2; lumbar spine, n = 2) were enrolled and treated with percutaneous cryoablation. The primary endpoint was the evaluation of the treatment safety as determined using step-by-step registration. The secondary endpoints were the incidence and grade of adverse events by CTCAE version 4.0, and the short-term efficacy of this treatment. Based on a decrease in the numerical rating scale (NRS) score, efficacy was classified as significantly effective (SE ≥ 5 or reached 0-2), moderately effective (ME 2-4), or not effective (NE < 2 or increase). RESULTS Cryoablation procedures were completed in all patients. Major adverse events (≥ grade 3) related to the procedure were not observed. Minor adverse events (≤ grade2) were observed in 22-67%. The mean NRS score was 7 before treatment, 0.6 at 4-week, 0.1 at 6-month, and 0 at 1-year post-treatment. All procedures were classified as SE. CONCLUSION Percutaneous cryoablation is a safe treatment for OO. Future phase II trials with large patient cohorts are warranted.
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