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Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma
European Journal of Radiology, 08/11/09

Carrafiello G et al. – In a study to assess the safety and efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in 2 pts with painful bone metastases from hepatocellular carcinoma (HCC), it was found that RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and pain relief is substantial.

• 2 pts with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0cm diameter) under US (ultrasonography) and fluoroscopic guidance.
• 2 methods were used to determine response of both pts: the first method was to measure pt's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every wk for 1 mo, and thereafter at wk 8 and 12 (total follow-up 3 mos); the second method was to evaluate pt's analgesics use recorded at wk 1, 4, 8 and 12.
• Analgesic medication use was translated into a morphine-equivalent dose.

• RFA was well tolerated by the pts who did not develop any complication.
• Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 wks.
• In both pts, a reduction was observed in use of morphine dose-equivalent after a peak at wk 1.
• CT (computed tomography) imaging, performed at 1 mo after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed.

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