Image-guided cryoablation of painful metastatic bone tumors: a new and effective approach to a difficult problem
Number:27ESURABS0086
Type:Scientific Electronic Presentation
Authors: Ricardo Natel, Giovana Helfenstein, Felipe Figueirôa, Carolina Zaghini, Antonio Rahal, Fabio Vieira, Marcos De Queiroz, Rodrigo Gobbo
Keywords:Cryoablation; Neoplasm Metastasis; Radiotherapy; Bone Neoplasms; Magnetic Resonance Imaging.
SECTIONS
Objectives

The aim of this project is to provide evidence and to highlight Image-guided cryoablation of painful metastatic bone tumors as a new, developed and  effective technique regarding the patient’s case.

 

Material and methods

Retrospective case analysis regarding imaging exams, laboratory data and clinical-surgical outcome.

The case concerns a 53 years old woman who was admitted to the hospital due to back pain and paresthesia in the left lower limb, with a kidney neoplasia with bone and lung metastasis history. 

The Magnetic Resonance Imaging (MRI) demonstrated a nodular and hypoechoic area in the lower left renal pole. Furthermore, a solid and heterogeneous nodule with an exophytic and insinuation to the renal sinus fat was also revealed in the imaging exam. There wasn't signs of vascular invasion. She underwent a partial nephrectomy that confirmed a clear renal cell carcinoma. 

Moreover, another MRI eleven days later elucidates a heterogeneous nodule in the middle of the left kidney (tumoral recurrence) of which she underwent a total nephrectomy. After 3 months, the...

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The MRI showed a solid and heterogeneous nodule with an exophytic component and insinuation to the renal sinus fat. There wasn’t signs of vascular invasion.
MRI also showed a nodular and hypoechoic area in the lower left renal pole.
Results

Chronologically, percutaneous cryoablation has a history of successful treatment of neoplasia in several organs such as the prostate, the kidney, the liver and the uterus. The first-generation devices were limited due to the large diameter, the use of liquid nitrogen for tissue cooling and the lack of well insulated probes. The development of percutaneous cryoprobes is based on delivery of argon gas through a segmentally insulated probe and it involves a rapid expansion of this gas that results in a rapid cooling system, which reaches -148 °F within a few seconds. Moreover, the use of selected cryoprobes with small diameters (1,7 mm and 2,4 mm) and insulation along the shaft allows the use of these devices. Active thawing of the ice ball is achieved by the installation of helium gas. The cell death is due to the rapid freezing immediately adjacent to the probe results in...

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A palliative treatment was proposed with percutaneous cryoablation. The technique is the following: to place probes inside the foraminal components of the infiltrative lesion. Cycles of freezing, thawing and refreezing under continuous neurophysiological monitoring.
Conclusions

 Percutaneous ablation technique is a relevant alternative treatment for handling pain due to bony metastatic disease. Regarding this fact, significant pain reduction is possible in patients who have failed to achieve benefit from conventional therapies that include chemotherapy and external beam radiation. Importantly, the pain reduction that is achieved is durable for its patients.