Editing Bone tumor (section)

=== Thermal ablation techniques ===
Over the past two decades, CT guided [[radiofrequency ablation]] has emerged as a less invasive alternative to surgical resection in the care of benign bone tumors, most notably [[osteoid osteoma]]s. In this technique, which can be performed under conscious sedation, a RF probe is introduced into the tumor nidus through a cannulated needle under CT guidance and heat is applied locally to destroy tumor cells. Since the procedure was first introduced for the treatment of osteoid osteomas in the early 1990s,<ref>{{cite journal | vauthors = Rosenthal DI, Alexander A, Rosenberg AE, Springfield D | title = Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure | journal = Radiology | volume = 183 | issue = 1 | pages = 29–33 | date = April 1992 | pmid = 1549690 | doi = 10.1148/radiology.183.1.1549690 }}{{Dead link|date=November 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> it has been shown in numerous studies to be less invasive and expensive, to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques, with 66 to 96% of patients reporting freedom from symptoms.<ref>{{cite journal | vauthors = Rimondi E, Mavrogenis AF, Rossi G, Ciminari R, Malaguti C, Tranfaglia C, Vanel D, Ruggieri P | display-authors = 6 | title = Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients | journal = European Radiology | volume = 22 | issue = 1 | pages = 181–188 | date = January 2012 | pmid = 21842430 | doi = 10.1007/s00330-011-2240-1 | s2cid = 21047698 }}</ref><ref>{{cite journal | vauthors = Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ | title = Osteoid osteoma: percutaneous treatment with radiofrequency energy | journal = Radiology | volume = 229 | issue = 1 | pages = 171–175 | date = October 2003 | pmid = 12944597 | doi = 10.1148/radiol.2291021053 }}{{Dead link|date=November 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite journal | vauthors = Weber MA, Sprengel SD, Omlor GW, Lehner B, Wiedenhöfer B, Kauczor HU, Rehnitz C | title = Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection | journal = Skeletal Radiology | volume = 44 | issue = 7 | pages = 981–993 | date = July 2015 | pmid = 25910709 | doi = 10.1007/s00256-015-2139-z | s2cid = 21496405 }}</ref> While initial success rates with RFA are high, symptom recurrence after RFA treatment has been reported, with some studies demonstrating a recurrence rate similar to that of surgical treatment.<ref>{{cite journal | vauthors = Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ | title = Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 80 | issue = 6 | pages = 815–821 | date = June 1998 | pmid = 9655099 | doi = 10.2106/00004623-199806000-00005 | url = http://jbjs.org/content/80/6/815 | access-date = 2016-08-07 | url-status = dead | s2cid = 10709128 | citeseerx = 10.1.1.1018.5024 | archive-url = https://web.archive.org/web/20161006083133/http://jbjs.org/content/80/6/815 | archive-date = 2016-10-06 }}</ref>

Thermal ablation techniques are also increasingly being used in the palliative treatment of painful metastatic bone disease. Currently, external beam radiation therapy is the standard of care for patients with localized bone pain due to metastatic disease. Although the majority of patients experience complete or partial relief of pain following radiation therapy, the effect is not immediate and has been shown in some studies to be transient in more than half of patients.<ref>{{cite journal | vauthors = Tong D, Gillick L, Hendrickson FR | title = The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group | journal = Cancer | volume = 50 | issue = 5 | pages = 893–899 | date = September 1982 | pmid = 6178497 | doi = 10.1002/1097-0142(19820901)50:5<893::aid-cncr2820500515>3.0.co;2-y | doi-access = free }}</ref> For patients who are not eligible or do not respond to traditional therapies ( i.e. radiation therapy, chemotherapy, palliative surgery, bisphosphonates or analgesic medications), thermal ablation techniques have been explored as alternatives for pain reduction. Several multi-center clinical trials studying the efficacy of RFA in the treatment of moderate to severe pain in patients with metastatic bone disease have shown significant decreases in patient reported pain after treatment.<ref>{{cite journal | vauthors = Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, Lopez R, Safran H, DiPetrillo T | display-authors = 6 | title = Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial | journal = Cancer | volume = 116 | issue = 4 | pages = 989–997 | date = February 2010 | pmid = 20041484 | pmc = 2819592 | doi = 10.1002/cncr.24837 }}</ref><ref>{{cite journal | vauthors = Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, Wong GY, Sloan JA, Novotny PJ, Petersen IA, Beres RA, Regge D, Capanna R, Saker MB, Grönemeyer DH, Gevargez A, Ahrar K, Choti MA, de Baere TJ, Rubin J | display-authors = 6 | title = Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study | journal = Journal of Clinical Oncology | volume = 22 | issue = 2 | pages = 300–306 | date = January 2004 | pmid = 14722039 | doi = 10.1200/JCO.2004.03.097 | doi-access = free }}</ref> These studies are limited however to patients with one or two metastatic sites; pain from multiple tumors can be difficult to localize for directed therapy. More recently, [[cryoablation]] has also been explored as a potentially effective alternative as the area of destruction created by this technique can be monitored more effectively by CT than RFA, a potential advantage when treating tumors adjacent to critical structures.<ref>{{cite journal | vauthors = Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, Paz-Fumagalli R, Hoffman C, Atwell TD, Charboneau JW, Schmit GD, Goetz MP, Rubin J, Brown KJ, Novotny PJ, Sloan JA | display-authors = 6 | title = Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial | journal = Cancer | volume = 119 | issue = 5 | pages = 1033–1041 | date = March 2013 | pmid = 23065947 | pmc = 5757505 | doi = 10.1002/cncr.27793 }}</ref>