Percutaneous Image-Guided Ablation in the Treatment of Osseous Metastases from Non-small Cell Lung Cancer

  • Yuntong Ma
  • Adam N. Wallace
  • Saiama N. Waqar
  • Daniel Morgensztern
  • Thomas P. Madaelil
  • Anderanik Tomasian
  • Jack W. Jennings
Clinical Investigation



Percutaneous image-guided ablation is an emerging minimally invasive therapy for patients with metastatic bone disease for whom radiation therapy is ineffective or contraindicated. The purpose of this study was to examine the safety and efficacy of percutaneous ablation in achieving pain palliation and local tumor control of osseous metastases from non-small cell lung cancer (NSCLC).


A retrospective review was performed of 76 musculoskeletal metastases in 45 patients treated with percutaneous ablation. 63% (48/76) were treated with radiofrequency ablation (RFA), 35% (27/76) with cryoablation, and 1.3% (1/76) with microwave ablation (MWA). In 70% (53/76) of cases, associated cementoplasty was performed. Primary outcomes measured were pre- and post-procedure pain scores 4 weeks after treatment and local tumor control at 3-, 6-, and 12-month follow-up.


Mean age of the cohort was 63.6 ± 9.5 years. Median tumor diameter was 3.60 cm (range 1.0–10.0 cm). Mean and median pain scores before treatment were 7.5 ± 2.3 and 8.0, respectively. Post-procedure, patients reported significantly decreased pain scores at 4 weeks (mean, 3.7 ± 3.5; median, 3.0; p < 0.00001). Radiographic local tumor control rates were 83% (35/42) at 3 months, 77% (23/30) at 6 months, and 68% (17/25) at 12 months after treatment. The overall complication rate was 2.6% (2/76).


Percutaneous tumor ablation is a well-tolerated, minimally invasive procedure associated with improving pain palliation and achieving local tumor control of osseous metastases from NSCLC.

Level of Evidence

Level 4, case series.


NSCLC Osseous metastases Pain palliation Local tumor control Radiofrequency ablation Cryoablation Microwave ablation Cementoplasty 


Compliance with Ethical Standards

Conflict of interest

Jack W. Jennings is a paid consultant for Merit Medical Inc. and Medtronic. Anderanik Tomasian is a paid consultant for Medtronic. On behalf of the remaining authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

Informed Consent

Informed consent was waived for retrospective study participation.


  1. 1.
    Ferlay J, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.CrossRefPubMedGoogle Scholar
  2. 2.
    Molina JR, et al. Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. Mayo Clin Proc. 2008;83(5):584–94.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001;27(3):165–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Kosteva J, Langer C. The changing landscape of the medical management of skeletal metastases in nonsmall cell lung cancer. Curr Opin Oncol. 2008;20(2):155–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Tsuya A, et al. Skeletal metastases in non-small cell lung cancer: a retrospective study. Lung Cancer. 2007;57(2):229–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Berenson JR, Rajdev L, Broder M. Managing bone complications of solid tumors. Cancer Biol Ther. 2006;5(9):1086–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Chow E, et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol). 2012;24(2):112–24.CrossRefGoogle Scholar
  8. 8.
    Masucci GL, et al. Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice. Expert Rev Anticancer Ther. 2011;11(12):1923–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Ricardi U, Badellino S, Filippi AR. Stereotactic body radiotherapy for early stage lung cancer: history and updated role. Lung Cancer. 2015;90(3):388–96.CrossRefPubMedGoogle Scholar
  10. 10.
    Yao YH, et al. Attenuated LKB1-SIK1 signaling promotes epithelial-mesenchymal transition and radioresistance of non-small cell lung cancer cells. Chin J Cancer. 2016;35:50.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gangi A, Buy X. Percutaneous bone tumor management. Semin Intervent Radiol. 2010;27(2):124–36.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Intervent Radiol. 2010;27(3):276–84.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wallace AN, et al. Percutaneous image-guided cryoablation of musculoskeletal metastases: pain palliation and local tumor control. J Vasc Interv Radiol. 2016;27(12):1788–96.CrossRefPubMedGoogle Scholar
  14. 14.
    Wallace AN, et al. The metastatic spine disease multidisciplinary working group algorithms. Oncologist. 2015;20(10):1205–15.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wallace AN, Greenwood AM, Taylor J, Jennings JW. Use of imaging in the management of metastatic spine disease with percutaneous ablation and vertebral augmentation. AJR Am J Roentgenol. 2015;205(2):434–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Wallace AN, et al. Radiographic local control of spinal metastases with percutaneous radiofrequency ablation and vertebral augmentation. AJNR Am J Neuroradiol. 2016;37(4):759–65.CrossRefPubMedGoogle Scholar
  17. 17.
    Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol. 2015;124(1):111–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Hillen TJ, et al. Treatment of metastatic posterior vertebral body osseous tumors by using a targeted bipolar radiofrequency ablation device: technical note. Radiology. 2014;273(1):261–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Rybak LD, et al. Thermal ablation of spinal osteoid osteomas close to neural elements: technical considerations. AJR Am J Roentgenol. 2010;195(4):W293–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Ahmed M, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. J Vasc Interv Radiol. 2014;25(11):1691-705 e4.PubMedGoogle Scholar
  21. 21.
    Omary RA, et al. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2002;13(9 Pt 1):879–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3(4):310–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Sacks D, et al. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.CrossRefPubMedGoogle Scholar
  24. 24.
    Anchala PR, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician. 2014;17(4):317–27.PubMedGoogle Scholar
  25. 25.
    Pusceddu C, et al. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24(2):229–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  1. 1.Washington University School of MedicineSt. LouisUSA
  2. 2.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  3. 3.Division of Medical OncologyWashington University School of MedicineSt. LouisUSA
  4. 4.Department of Radiology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations