Interventional procedure overview of radiofrequency ablation for palliation of painful spinal metastases

Existing assessments of this procedure

CIRSE standards of practice guideline recommends that 'RFA is indicated for osteolytic or mixed osteolytic– osteoblastic lesions with no, or a small, extra-osseous component. Where an extra-osseus soft tissue component exists, ablation of the soft tissue–bone interface can achieve pain palliation' (Ryan 2022).

The National Comprehensive Cancer Network (NCCN) guidelinestates that radiofrequency ablation of bone lesions may be performed to reduce pain and prevent skeletal related events. Radiofrequency ablation of bone lesions has proven successful in pain management, especially for those who do not attain adequate analgesia without intolerable effects (Swarm 2020).

European Society for Medical Oncology (ESMO) guidelinesstates that 'RFA can also relieve pain from bone metastases and reduce the tumour burden in bone. Minimally invasive RFA and vertebroplasty or kyphoplasty are used in combination to reduce tumour mass, create a cavity and stabilise the vertebral body' (Coleman R 2020).

A recently published guideline on percutaneous vertebral augmentation recommends treatment with vertebroplasty following different tumour treatments (like RFA) in patients with painful vertebrae due to metastases to achieve pain relief and the consolidation of vertebra (Tsoumakidou G 2017).

NICE guideline on 'metastatic spinal cord compression in adults: risk assessment, diagnosis and management' in section 1.5.1.8 recommends to 'consider vertebroplasty or kyphoplasty for patients who have vertebral metastases and no evidence of metastatic spinal cord compression or spinal instability if they have: mechanical pain resistant to conventional analgesia, or vertebral body collapse' (NICE clinical guideline CG75, 2008).