Abstract

Background: Metastatic patients are living longer. Bone metastases are associated to pathological fractures, severe pain, and functional impairment. There is evidence of pain relief and functional improvement after Radiofrequency Ablation (RFA) and/or cementing. These procedures present a synergistic effect. Intramedullary nailing allows immediate weight bearing and complements stabilization, pain and functional improvements. In this study, a combined palliative local treatment for multiple bone metastases aims to relief pain and improve function.

Methods: Prospectively were analysed 30 patients and a total of 32 long bone metastases treated with local curettage, RFA, cement filling, and internal fixation. It was evaluated pain (Visual Analogue Scale), function (Karnofsky Performance Score), treatment complications, and survival. Local tumour progression was evaluated on radiographs and CT scan.

Results: Mean follow-up was 17.5 months (range 1-63). All patients experienced immediate pain relief 15 days after treatment. Mean VAS improved from 8.63 (SD 0.75, range 7-10) to 3.72 (SD 1.92, range 0-7). The mean VAS reduced even more at 6 weeks to 2.5 (SD 1.77, range 0-6) and at final follow up stabilized at 2.19 (SD 1.77, range 0-6). The postoperative improvement is statistically significant for all time visits (p<0.0001). The preoperative mean functional KPS was 57.7 (SD 14.55, range 30-80) compared to 74 (SD 16.32, range 40-100) postoperatively (p<0.0001). There was no evidence of local disease progression. There were no reported complications. Mean survival was 23.0 months (SD 4.35, 95% CI range 14.5-31.6).

Conclusion: The combined treatment presented rapid pain relief and significant functional improvement impacting on quality of life. This study shows an effective local tumour control. RFA, cementing, and internal fixation should be incorporated in multidisciplinary discussion since the beginning in order to be used early in the treatment algorithm. Patients with short to medium-term survival significantly benefit from this treatment.

Keywords: Long one metastases; Radiofrequency ablation; Cementing; Internal fixation; Pain; Function; Local tumour control; Quality of life