CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1735–1742 | Cite as

Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk

  • A. Nicholas KurupEmail author
  • Grant D. Schmit
  • Thomas D. Atwell
  • Erik B. Sviggum
  • Wilfrido R. Castaneda
  • Peter S. Rose
  • Matthew R. Callstrom
Clinical Investigation
Part of the following topical collections:
  1. Non-Vascular Interventions



To characterize the response of patients with acetabular metastases following combined cryoablation and cementoplasty (CCC) for pain palliation and fracture risk reduction, based on completeness of ablation and the presence of pre-existing pathologic fracture.

Materials and Methods

Thirty-nine consecutive acetabular CCC procedures were performed in 37 patients (24 M:13F, age 66 ± 8 years). Pain was assessed using a 0–10 numeric rating scale. Development of new or progression of pre-existing fractures and local tumor progression (LTP) were determined on follow-up imaging. Pain score reduction and fracture development rates were compared by ablation completeness and the presence of pre-existing fractures.


Twenty-three of 27 (85%) patients with evaluable pain scores had reduced pain, decreasing from 7.5 ± 2.1 to 3.6 ± 2.6 (p < 0.0001). Of 39 tumors, 28 (72%) were completely ablated with no significant difference in pain reduction after complete versus incomplete ablations (p = 0.9387). Six of 30 (20%) patients with follow-up imaging demonstrated new/progressive acetabular fractures. Four of 5 (80%) patients with LTP developed new/progressive fractures compared to 2 of 25 (8%) without tumor progression (p = 0.0003). Pre-existing fracture was not associated with subsequent fracture/fracture progression (p = 0.2986). However, patients with prior acetabular radiation therapy or surgery had increased fractures following treatment (p = 0.0380).


Complete acetabular tumor ablation during CCC was not associated with superior pain relief compared to subtotal ablation but did result in improved fracture stabilization. Pre-treatment pathologic fractures were not associated with fracture progression, but new/progressive fractures were more frequent in patients with prior radiation therapy or surgery.


Acetabulum Cryoablation Percutaneous cementoplasty Palliative treatment Pathologic fracture 


Compliance with Ethical Standards

Conflict of interest

ANK and MRC receive royalties from UpToDate, Inc. and have received research support from Galil Medical. MRC also has received research grants from General Electric Medical Systems, Thermedical, and Siemens Medical. MRC is a paid consultant for Covidien.


  1. 1.
    Hernandez RK, Adhia A, Wade SW, et al. Prevalence of bone metastases and bone-targeting agent use among solid tumor patients in the United States. Clin Epidemiol. 2015;7:335–45.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Dorrepaal KL, Aaronson NK, van Dam FSAM. Pain experience and pain management among hospitalized cancer patients. Cancer. 1989;63:593–8.CrossRefGoogle Scholar
  3. 3.
    Janjan N, Lutz ST, Bedwinek JM, et al. Therapeutic guidelines for the treatment of bone metastasis: a report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology. J Palliat Med. 2009;12:417–26.CrossRefGoogle Scholar
  4. 4.
    Callstrom MR, Dupuy DE, Solomon SB, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013;119:1033–41.CrossRefGoogle Scholar
  5. 5.
    Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22:300–6.CrossRefGoogle Scholar
  6. 6.
    Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24:229–33.CrossRefGoogle Scholar
  7. 7.
    Dupuy DE, Liu D, Hartfeil D, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116:989–97.CrossRefGoogle Scholar
  8. 8.
    Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D. Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol. 2008;31:1165–73.CrossRefGoogle Scholar
  9. 9.
    Kelekis A, Lovblad KO, Mehdizade A, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J. Vasc Int Radiol JVIR. 2005;16:81–8.CrossRefGoogle Scholar
  10. 10.
    Lane MD, Le HB, Lee S, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol. 2011;40:25–32.CrossRefGoogle Scholar
  11. 11.
    Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol. 2014;43:1551–9.CrossRefGoogle Scholar
  12. 12.
    Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol. 2016;39:74–80.CrossRefGoogle Scholar
  13. 13.
    Wallace AN, Huang AJ, Vaswani D, Chang RO, Jennings JW. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note. Skeletal Radiol. 2016;45:401–5.CrossRefGoogle Scholar
  14. 14.
    Friedman MV, Hillen TJ, Wessell DE, Hildebolt CF, Jennings JW. Hip chondrolysis and femoral head osteonecrosis: a complication of periacetabular cryoablation. J Vasc Interv Radiol. 2014;25:1580–8.CrossRefGoogle Scholar
  15. 15.
    Kurup AN, Schmit GD, Morris JM, et al. Avoiding complications in bone and soft tissue ablation. Cardiovasc Intervent Radiol. 2017;40:166–76.CrossRefGoogle Scholar
  16. 16.
    Prologo JD, Patel I, Buethe J, Bohnert N. Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol. 2014;25(769–75):e2.Google Scholar
  17. 17.
    Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care. 2014;8:83–90.CrossRefGoogle Scholar
  18. 18.
    Kurup AN, Morris JM, Schmit GD, et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol. 2015;26:588–94.CrossRefGoogle Scholar
  19. 19.
    Castaneda Rodriguez WR, Callstrom MR. Effective pain palliation and prevention of fracture for axial-loading skeletal metastases using combined cryoablation and cementoplasty. Tech Vasc Interv Radiol. 2011;14:160–9.CrossRefGoogle Scholar
  20. 20.
    Kurup AN, Morris JM, Boon AJ, et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol. 2014;25:1657–64.CrossRefGoogle Scholar
  21. 21.
    Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria-A 10-Year Update. Radiology. 2014;273:241–60.CrossRefGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  23. 23.
    Campbell I. Chi squared and Fisher–Irwin tests of two-by-two tables with small sample recommendations. Stat Med. 2007;26:3661–75.CrossRefGoogle Scholar
  24. 24.
    Richardson JT. The analysis of 2 × 2 contingency tables–yet again. Stat Med. 2011;30:890 (author reply 1–2).CrossRefGoogle Scholar
  25. 25.
    Callstrom MR, Charboneau JW, Goetz MP, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol. 2006;35:1–15.CrossRefGoogle Scholar
  26. 26.
    Coupal TM, Pennycooke K, Mallinson PI, et al. The hopeless case? Palliative cryoablation and cementoplasty procedures for palliation of large pelvic bone metastases. Pain Physician. 2017;20:E1053–61.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • A. Nicholas Kurup
    • 1
    Email author
  • Grant D. Schmit
    • 1
  • Thomas D. Atwell
    • 1
  • Erik B. Sviggum
    • 3
  • Wilfrido R. Castaneda
    • 4
  • Peter S. Rose
    • 2
  • Matthew R. Callstrom
    • 1
  1. 1.Department of Radiology (ANK, GDS, TDA, MRC)Mayo ClinicRochesterUSA
  2. 2.Department of Orthopedic Surgery (PRS)Mayo ClinicRochesterUSA
  3. 3.Department of Radiology (EBS)Mayo Clinic Health SystemEau ClaireUSA
  4. 4.Department of Radiology (WRC)Park NicolletSt. Louis ParkUSA

Personalised recommendations