Algemeen: R.F.A. - Radio Frequency Ablation kan als pijnbestrijding bij uitzaaiïngen in de botten succesvol worden ingezet. Nieuwe studie toegevoegd

Aan dit artikel is enkele uren gewerkt. Opzoeken, vertalen, plaatsen enz. Als u ons wilt ondersteunen dan kan dat via een al of niet anonieme donatie. Elk bedrag is welkom hoe klein ook. Klik hier als u ons wilt helpen kanker-actueel online te houden Wij zijn een ANBI organisatie en dus is uw donatie aftrekbaar voor de belasting

28 februari 2012: Bron: Cancer. Cancer. 2010 February 15; 116(4): 989–997. doi: 10.1002/cncr.24837

Uit een studie uit 2002 bleek dat 95% van de patiënten significante pijnverlichting ervaart na een behandeling met RFA - Radio Frequency Ablation. Bij 69% hield deze pijnverlichting tot een half jaar na de RFA behandeling aan. Vorig jaar werd een studie gepubliceerd waarbij RFA werd toegepast bij 50 patiënten met botuitzaaiïngen die daaraan veel pijn hadden. De RFA werd ingezet om de pijn te verlichten en deze studie toont aan dat RFA een heel goede behandeling kan zijn voor pijnverlichting veroorzaakt door bottumoren. Tot zelfs 8 cm. in doorsnee konden bottumoren worden weggehaald.

Resultaten
Bij 55 patiënten werd een volledige RFA uitgevoerd. Slechts bij 3 patiënten (5%) ontstonden complicaties met een graad 3. De RFA behandeling zorgde bij alle patiënten voor minder pijn op zowel 1 en 3 maanden voor alle aan pijn gerelateerde doelstellingen van de studie. De gemiddelde vermindering van de pijn van voor de RFA behandeling bij de meting na 1 maand bleek 26,27
(95% BI, 17,65 tot 34,89, P <0,0001) en de toename van de pijnvermindering voor de RFA behandeling op meting na 3 maanden follow-up is 16.38 (95 % BI, 3,37 tot 29,39, P = 0,02).
De gemiddelde afname van de intensiteit van de pijn van voor de RFA na 1 maand follow-up was 26,9 (p <0,0001) en 14,2 na 3 maanden follow-up (p = 0,02).
De kans om minder ernstige pijn te hebben na 1 maand follow-up is 14.03 keer hoger vergeleken met voor de RFA (95% BI, 2,33 tot 25,73, P <0,0001), en de kans na 3 maanden follow-up is 8,00 keer hoger in vergelijking met voor de RFA (95% BI, 0,85 tot 15,15, P <0,001).
De gemiddelde stijging van het welbevinden van de patiënt van voor de RFA na 1 maand follow-up was 19,9 (P <0,0001) en 14,9 na 3 maanden follow-up (p = 0,005).

Conclusie:
De onderzoekers wijzen er met nadruk op dat RFA - Radio Frequency Ablation een veilig behandeling is die de pijn kan verzachten van botmetastasen.

Hieronder het abstract van de studie. Als u hier klikt kunt u het volledige studierapport gratis inzien. Plus een referentielijst van gerelateerde studies.

RFA - Radio frequency Ablation can safely palliate pain from bone metastases

Cancer. Author manuscript; available in PMC 2011 February 15.

Published in final edited form as:

Cancer. 2010 February 15; 116(4): 989–997.

doi: 10.1002/cncr.24837

PMCID: PMC2819592

NIHMSID: NIHMS158485

Percutaneous Radiofrequency Ablation of Painful Osseous Metastases: A Multi-center American College of Radiology Imaging Network Trial

Damian E. Dupuy, M.D.,¹ Dawei Liu, Ph.D.,⁹ Donna Hartfeil, RN,⁵ Lucy Hanna, Ph.D.,⁴ Jeffrey D. Blume, Ph.D.,^4,⁸ Kamran Ahrar, M.D.,⁶ Robert Lopez, M.D.,⁷ Howard Safran, M.D.,² and Thomas DiPetrillo, M.D.³

¹ Department of Diagnostic Imaging, The Warren Alpert Medical School at Brown University

² Department of Hematology/Oncology, The Warren Alpert Medical School at Brown University

³ Department of Radiation Medicine, The Warren Alpert Medical School at Brown University

⁴ Center for Statistical Sciences, Brown University

⁵ American College of Radiology Imaging Network (ACRIN)

⁶ MD Anderson Cancer Center

⁷ University of Alabama at Birmingham Medical Center

⁸ Department of Biostatistics, Vanderbilt University School of Medicine

⁹ Department of Statistics, Unversity of Iowa

Corresponding Author: Damian E. Dupuy, M.D., Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, Tel. 401-444-5184, Fax 401-444-5017, Email: ddupuy@lifespan.org

The publisher's final edited version of this article is available at Cancer

See other articles in PMC that cite the published article.

Other Sections▼

Abstract

Background

To determine if radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease.

Methods

A single arm prospective trial in patients with a single painful bone metastasis with unremitting pain of at least a score above 50 on a pain scale of 0–100. Percutaneous CT guided RFA of the bone metastasis to temperatures above 60 degrees Celsius was performed.

Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, one and three months after RFA.

Results

55 patients completed RFA. Grade 3 toxicities occurred in 3 of 55 patients (5%). RFA reduced pain at 1- and 3-month for all pain assessment measures. The average increase in pain relief from pre-RFA to 1-month follow-up is 26.27 (95% CI, 17.65 to 34.89, P<0.0001) and the increase from pre-RFA to 3-month follow-up is 16.38 (95% CI, 3.37 to 29.39, P=0.02). The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9 (P<0.0001) and 14.2 for 3-month follow-up (P=0.02). The odds of being in lower pain severity at 1-month follow-up is 14.03 (95% CI, 2.33 to 25.73, P<0.0001) times higher than that at pre-RFA, and the odds at 3-month follow-up is 8.00 (95% CI, 0.85 to 15.15, P<0.001) times higher than that at pre-RFA. The average increase in mood from pre-RFA to 1-month follow-up was 19.9 (P<0.0001) and 14.9 for 3-month follow-up (P=0.005).

Conclusion

This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases.

References

References:

1. Stoll BA, Parbhoo S, editors. Bone Metastasis: Monitoring and Treatment. New York: Raven Press; 1983.

2. Twycross RG. Management of pain in skeletal metastases. Clin Ortho. 1995;312:187–196.

3. Janjan NA. Radiation for bone metastases: conventional techniques and the role of systemic pharmaceuticals. Cancer. 1997;80:1628–1645. [PubMed]

4. Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer.Radiother Oncol. 1994;31:33–40. [PubMed]

5. Serafini AN, Houston SJ, Resche I, Quick DP, Grund FM, Ell PJ, et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double blind placebo-controlled trial. J Clin Oncol. 1998;16:1574–1581. [PubMed]

6. Hortobagyi GB, Theriault RL, Porter L, Blayney D, Lipton A, Sinoff C, et al. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. Protocol 19 Aredia Breast Cancer Study Group. N Engl J Med. 1999;12:1785–1791.

7. Conte PF, Latreille J, Mauriac L, Calabresi F, Santos R, Campos D, et al. Delay in progression of bone metastases in breast cancer patients treated with intravenous pamidronate: results from a multinational randomized controlled trial. The Aredia Multinational Cooperative Group. J Clin Oncol.1996;14:2552–2559. [PubMed]

8. Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases; final results of the study by the radiation therapy oncology group. Cancer. 1982;50:893–899. [PubMed]

9. Madsen EL. Painful bone metastasis: efficacy of radiotherapy assessed by the patients: a randomized trial comparing 4Gy versus 10Gy x 2. Int J Radiat Oncol Biol Phys. 1983;9:1775–1779.[PubMed]

10. Blitzer PH. Reanalysis of then RTOG study of the palliation of symptomatic osseous metastasis.Cancer. 1984;55:1468–1472. [PubMed]

11. Price P, Hoskin PJ, Easton D, Austin D, Palmer SG, Yarnold JR. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases.Radiother Oncol. 1986;6:247–255. [PubMed]

12. Arcangeli G, Micheli A, Arcangeli G, Gainnarelli D, La Pasta O, Tollis A, et al. The responsiveness of bone metastases to radiotherapy: the effect of site, histology and radiation dose on pain relief.Radiother Oncol. 1989;14:95–101. [PubMed]

13. Cole DJ. A randomized trial of a single treatment versus conventional fractionation in the palliative radiotherapy of painful bone metastases. Clin Oncol. 1989;1:59–62.

14. Poulter CA, Cosmatos D, Rubin P, Urtasun R, Cooper JS, Kuske RR, et al. A report of RTOG 8206: a phase III study of whether the addition of single dose hemibody irradiation to standard fractionated local field irradiation is more effective that local field irradiation alone in the treatment of symptomatic osseous metastases. Int J Radiat Oncol Biol Phys. 1992;23:207–214. [PubMed]

15. Arcangeli G, Giovinazzo G, Saracino B, D’Angelo L, Giannarelli D, Arcangeli G, et al. Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration. Int J Radiat Oncol Biol Phys. 1998;42:1119–1126. [PubMed]

16. Ratanatharathorn V, Powers WE, Moss WT, Perez CA. Bone metastasis: review and critical analysis of random allocation trials of local field treatment. Int J Radiat Oncol Biol Phys. 1999;44:1–18. [PubMed]

17. Agarawal JP, Swangsilpa T, van der Linden Y, Rades D, Jeremic B, Hoskin PJ. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol (R Coll Radiol)2006;18:747–60. [PubMed]

18. Cleeland CS. The measurement of pain from metastatic bone disease: capturing the patient’s experience. Clin Cancer Res. 2006;12:6236s–6242s. [PubMed]

19. Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Wong GY, Sloan JA, et al. Painful metastases involving bone: feasibility of percutaneous CT and US-guided radio-frequency ablation. Radiology.2002;224:87–97. [PubMed]

20. Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multi-center study. J Clin Oncol. 2004;22:300–306. [PubMed]

21. Fishman B, Pasternak S, Wallenstein SL, House RW, Holland JC, Foley KM. The memorial pain assessment card. A valid instrument for the evaluation of cancer pain. Cancer. 1987;60:1151–1158.[PubMed]

22. Little RJA, Rubin DB. Statistical analysis with missing data. New York: Wiley; 2002.

23. Hedeker D, Gibbons RD. Application of random-effects pattern mixture models for missing data in longitudinal studies. Psychol Methods. 1997;2:64–78.

24. Gangi A, Kastler BA, Klinkert A, Dietemann JL. Injection of alcohol into bone metastases under CT guidance. J Comput Assist Tomogr. 1994;18:932–935. [PubMed]

25. Levine SA, Perin LA, Hayes D, Hayes WS. An evidence-based evaluation of percutaneous vertebroplasty. Manag Care. 2000;9:56–60. 63. [PubMed]

26. Dupuy DE, Hong RJ, Oliver B, Goldberg SN. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. Am J Roentgenol. 2000;175:1263–1266. [PubMed]

27. Rosenthal DI, Hornicek FJ, Wolf MW, Jennings LC, Gebhardt MC, Mankin HJ. Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am. 1998;80:815–821. [PubMed]

28. Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. J Neurosurg. 1974;40:143–156. [PubMed]

29. Sluijter ME. The use of radiofrequency lesions for pain relief in failed back patients. Int Disabil Studies. 1988;10:37–43.

30. Ogsbury JS, Simons H, Lehman RAW. Facet denervation in treatment of low back syndrome.Pain. 1977;2:257–263. [PubMed]

31. Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the eastern cooperative oncology group. Ann Intern Med.1993;119:121–126. [PubMed]

32. Moryl N, Coyle N, Foley KM. Managing an acute pain crisis in a patient with advanced cancer: this is as much of a crisis as a code. JAMA. 2008;299:1457–1467. [PubMed]

33. Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008;149:369–379. [PMC free article] [PubMed]

34. Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97:798–804.[PubMed]

35. Agresti A. An Introduction to Categorical Data Analysis. New York: Wiley; 2007.

36. Grieco CA, Simon CJ, Mayo-Smith WW, Dipetrillo TA, Ready NE, Dupuy DE. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses. Am J Clin Oncol.2007;30:361–367. [PubMed]

botuitzaaiïngen, Radio Frequency Ablation, RFA, bottumoren, pijnbestrijding