Skip to main content

Advertisement

SpringerLink
Log in

The Role of Ablation in Cancer Pain Relief

  • Palliative Medicine (A Jatoi, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to describe the concepts of ablation techniques for pain relief in symptomatic oncologic patients. Controversies concerning techniques and products will be addressed.

Recent Findings

Despite conventional pain palliative techniques, cancer patients often endorse unresolved somatic and neuropathic pain that can present as a great burden to quality of life. In non-operative patients, several techniques have been applied to minimize opioid dependence. While radiotherapy is often considered as a non-invasive option, percutaneous ablation has been advanced as a minimally-invasive alternative with clear procedural and outcome advantages. Similar to radiation therapy, percutaneous ablation techniques can act either upon nerve structures responsible for pain mediation signals (neurolysis) or directly upon the tumor to relieve tumor-mediated inflammation and decompress tumor compression of adjacent structures.

Summary

Percutaneous ablation provides valuable neurolysis and tumor-directed pain palliative effects to be incorporated into clinical guidelines for pain reduction in oncologic patients. Selection among different ablation techniques should be based upon an individually tailored approach, to include consideration of all treatment modalities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Filippiadis DK, Tselikas L, Tsitskari M, Kelekis A, de Baere T, Ryan AG. Percutaneous Neurolysis for Pain Management in Oncological Patients. Cardiovasc Intervent Radiol. 2019;42(6):791–9. https://doi.org/10.1007/s00270-019-02185-x Recent multi-centered review providing details as well as tips and tricks for all kinds of percutaneous neurolysis techniques.

    Article  PubMed  Google Scholar 

  2. ESMO Guidelines working group. Bone health in cancer patients: ESMO clinical practice guidelines. Ann Oncol. 2014;25(Supplement 3):iii124–37. https://doi.org/10.1093/annonc/mdu103.

    Article  Google Scholar 

  3. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070–1090.e9. https://doi.org/10.1016/j.jpainsymman.2015.12.340.

    Article  Google Scholar 

  4. Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain. 1997;69:1–18.

    Article  CAS  Google Scholar 

  5. • Moynagh MR, Kurup AN, Callstrom MR. Thermal Ablation of Bone Metastases. Semin Interv Radiol. 2018;35(4):299–308. https://doi.org/10.1055/s-0038-1673422 Review providing details as well as tips and tricks for all kinds of percutaneous ablation techniques for osseous metastatic disease.

    Article  Google Scholar 

  6. WHO. Cancer pain relief: with a guide to opioid availability. 2nd ed. 1996. http://apps.who. int/iris/bitstream/10665/37896/1/9241544821.pdf.

  7. Martin BC, Fan MY, Edlund MJ, DeVries A, Braden JB, Sullivan MD. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med. 2011;26:1450–7. https://doi.org/10.1007/s11606-011-1771-0.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ballantyne JC, Kalso E, Stannard C. WHO analgesic ladder: a good concept gone astray. BMJ. 2016;6(352):i20. https://doi.org/10.1136/bmj.i20.

    Article  Google Scholar 

  9. Vayne-Bossert P, Afsharimani B, Good P, Gray P, Hardy J. Interventional options for the management of refractory cancer pain--what is the evidence? Support Care Cancer. 2016;24(3):1429–38. https://doi.org/10.1007/s00520-015-3047-4.

    Article  PubMed  Google Scholar 

  10. Dennis K, Makhani L, Zeng L, Lam H, Chow E. Single fraction conventional external beam radiation therapy for bone metastases: a systematic review of randomised controlled trials. Radiother Oncol. 2013;106(1):5–14. https://doi.org/10.1016/j.radonc.2012.12.009.

    Article  PubMed  Google Scholar 

  11. Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic osseous pain control: bone ablation and Cementoplasty. Semin Interv Radiol. 2017;34(4):328–36. https://doi.org/10.1055/s-0037-1608747.

    Article  Google Scholar 

  12. Filippiadis D, Tutton S, Kelekis A. Pain management: the rising role of interventional oncology. Diagn Interv Imaging. 2017;98(9):627–34. https://doi.org/10.1016/j.diii.2017.06.015.

    Article  CAS  PubMed  Google Scholar 

  13. Tam A, Ahrar K. Palliative interventions for pain in Cancer patients. Semin Interv Radiol. 2007;24:419–29. https://doi.org/10.1055/s-2007-992330.

    Article  Google Scholar 

  14. Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, et al. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 2016;33(12):140. https://doi.org/10.1007/s12032-016-0848-3.

    Article  PubMed  Google Scholar 

  15. Sidana A. Cancer immunotherapy using tumor cryoablation. Immunotherapy. 2014;6(1):85–93. https://doi.org/10.2217/imt.13.151.

    Article  CAS  PubMed  Google Scholar 

  16. Lubner MG, Brace CL, Hinshaw JL, Lee FT Jr. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol. 2010;21(8 Suppl):S192–203. https://doi.org/10.1016/j.jvir.2010.04.007.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Napoli A, Anzidei M, Marincola BC, Brachetti G, Noce V, Boni F, et al. MR imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics. 2018;38(2):603–23. https://doi.org/10.1148/rg.2018170129.

    Article  PubMed  Google Scholar 

  18. Mastier C, Gjorgjievska A, Thivolet A, Bouhamama A, Cuinet M, Pilleul F, et al. Musculoskeletal metastases management: the interventional Radiologist's toolbox. Semin Interv Radiol. 2018;35(4):281–9. https://doi.org/10.1055/s-0038-1673420.

    Article  Google Scholar 

  19. Scheffer HJ, Nielsen K, de Jong MC, van Tilborg AAJM, Vieveen JM, Bouwman A(RA), et al. Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. J Vasc Interv Radiol. 2014;25(7):997–1011. https://doi.org/10.1016/j.jvir.2014.01.028.

    Article  PubMed  Google Scholar 

  20. Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics. 2005;25(Suppl 1):S69–83. https://doi.org/10.1148/rg.25si055501.

    Article  PubMed  Google Scholar 

  21. Drewes AM, Campbell CM, Ceyhan GO, Delhaye M, Garg PK, van Goor H, et al. Pain in pancreatic ductal adenocarcinoma: a multidisciplinary, international guideline for optimized management. Pancreatology. 2018;18(4):446–57. https://doi.org/10.1016/j.pan.2018.04.008.

    Article  PubMed  Google Scholar 

  22. Yarmohammadi H, Nakamoto DA, Azar N, Hayek SM, Haaga JR. Percutaneous computed tomography guided cryoablation of the celiac plexus as an alternative treatment for intractable pain caused by pancreatic cancer. J Cancer Res Ther. 2011;7(4):481–3. https://doi.org/10.4103/0973-1482.92024.

    Article  PubMed  Google Scholar 

  23. Golovac S. Radiofrequency neurolysis. Neuroimaging Clin N Am. 2010;20(2):203–14. https://doi.org/10.1016/j.nic.2010.02.007.

    Article  PubMed  Google Scholar 

  24. Kastler B, Michalakis D, Clair CH, Allal R, Delabrousse E, Peireira PH, et al. Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study. JBR-BTR. 2001;84(5):191–4.

    CAS  PubMed  Google Scholar 

  25. Amr SA, Reyad RM, Othman AH, Mohamad MF, Mostafa MM, Alieldin NH, et al. Comparison between radiofrequency ablation and chemical neurolysis of thoracic splanchnic nerves for the management of abdominal cancer pain randomized trial. Eur J Pain. 2018;2(10):1782–90. https://doi.org/10.1002/ejp.1274.

    Article  Google Scholar 

  26. Bittman RW, Peters GL, Newsome JM, Friedberg EB, Mitchell JW, Knight JM, et al. Percutaneous image-guided Cryoneurolysis. AJR Am J Roentgenol. 2018;210(2):454–65. https://doi.org/10.2214/AJR.17.18452.

    Article  PubMed  Google Scholar 

  27. Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS. CT-guided celiac plexus Neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. RadioGraphics. 2011;31(6):1599–621. https://doi.org/10.1148/rg.316115526.

    Article  PubMed  Google Scholar 

  28. Nabil Abbas D, Abd el Ghafar EM, Ibrahim WA, Omran AF. Fluoroscopic stellate ganglion block for Postmastectomy pain: a comparison of the classic anterior approach and the oblique approach. Clin J Pain. 2011;27(3):207–13. https://doi.org/10.1097/AJP.0b013e3181fb1ef1.

    Article  PubMed  Google Scholar 

  29. Gangi A, Dietemann JL, Schultz A, Mortazavi R, Jeung MY, Roy C. Interventional radiologic procedures with CT guidance in cancer pain management. RadioGraphics. 1996;16(6):1289–304; discussion 1304-6. https://doi.org/10.1148/radiographics.16.6.8946536.

    Article  CAS  PubMed  Google Scholar 

  30. Narouze S. Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep. 2014;18(6):424. https://doi.org/10.1007/s11916-014-0424-5.

    Article  PubMed  Google Scholar 

  31. Hol PK, Kvarstein G, Viken O, Smedby O, Tonnessen TI. MRI-guided celiac plexus block. J Magn Reson Imaging. 2000;12(4):562–4.

    Article  CAS  Google Scholar 

  32. Wyse JM, Battat R, Sun S, Saftoiu A, Siddiqui AA, Leong AT, et al. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound. 2017;6(6):369–75. https://doi.org/10.4103/eus.eus_97_17.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Haynsworth RF Jr, Noe CE. Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiology. 1991;74(3):459–63.

    Article  Google Scholar 

  34. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345–60.

    PubMed  Google Scholar 

  35. Kawamata M, Ishitani K, Ishikawa K, Sasaki H, Ota K, Omote K, et al. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain. 1996;64(3):597–602.

    Article  CAS  Google Scholar 

  36. Filippiadis DK, Tutton S, Mazioti A, Kelekis A. Percutaneous image-guided ablation of bone and soft tissue tumours: a review of available techniques and protective measures. Insights Imaging. 2014;5(3):339–46. https://doi.org/10.1007/s13244-014-0332-6.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Interv Radiol. 2010;27(3):276–84. https://doi.org/10.1055/s-0030-1261786.

    Article  Google Scholar 

  38. Gangi A, Buy X. Percutaneous bone tumor management. Semin Interv Radiol. 2010;27(2):124–36. https://doi.org/10.1055/s-0030-1253511.

    Article  Google Scholar 

  39. Rosenthal D, Callstrom MR. Critical review and state of the art in interventional oncology: benign and metastatic disease involving bone. Radiology. 2012;262(3):765–80. https://doi.org/10.1148/radiol.11101384.

    Article  PubMed  Google Scholar 

  40. Gangi A, Tsoumakidou G, Buy X, Quoix E. Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol. 2010;33(4):706–13. https://doi.org/10.1007/s00270-009-9738-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. • Kurup AN, Schmit GD, Morris JM, Atwell TD, Schmitz JJ, Weisbrod AJ, et al. Avoiding complications in bone and soft tissue ablation. Cardiovasc Intervent Radiol. 2017;40(2):166–76. https://doi.org/10.1007/s00270-016-1487-y Recent review providing details as well as tips and tricks for avoiding complications during bone ablation.

    Article  PubMed  Google Scholar 

  42. Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol. 2013;36(6):1624–8. https://doi.org/10.1007/s00270-013-0641-z.

    Article  PubMed  Google Scholar 

  43. Vaswani D, Wallace AN, Eiswirth PS, Madaelil TP, Chang RO, Tomasian A, et al. Radiographic local tumor control and pain palliation of sarcoma metastases within the musculoskeletal system with percutaneous thermal ablation. Cardiovasc Intervent Radiol. 2018;41(8):1223–32. https://doi.org/10.1007/s00270-018-1932.

    Article  PubMed  Google Scholar 

  44. Ma Y, Wallace AN, Waqar SN, Morgensztern D, Madaelil TP, Tomasian A, et al. Percutaneous image-guided ablation in the treatment of osseous metastases from non-small cell lung Cancer. Cardiovasc Intervent Radiol. 2018;41(5):726–33. https://doi.org/10.1007/s00270-017-1843-6.

    Article  PubMed  Google Scholar 

  45. Deib G, Deldar B, Hui F, Barr JS, Khan MA. Percutaneous microwave ablation and Cementoplasty: clinical utility in the treatment of painful Extraspinal osseous metastatic disease and myeloma. AJR Am J Roentgenol. 2019;212:1–8. https://doi.org/10.2214/AJR.18.20386.

    Article  Google Scholar 

  46. 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(1):74–80. https://doi.org/10.1007/s00270-015-1151-y.

    Article  PubMed  Google Scholar 

  47. Coupal TM, Pennycooke K, Mallinson PI, Ouellette HA, Clarkson PW, Hawley P, et al. The hopeless case? Palliative Cryoablation and Cementoplasty procedures for palliation of large pelvic bone metastases. Pain Physician. 2017;20(7):E1053–61.

    PubMed  Google Scholar 

  48. Gallusser N, Goetti P, Becce F, Vauclair F, Rüdiger HA, Bize PE, et al. Percutaneous image-guided cryoablation of painful bone metastases: a single institution experience. Orthop Traumatol Surg Res. 2019;105(2):369–74. https://doi.org/10.1016/j.otsr.2019.01.001.

    Article  PubMed  Google Scholar 

  49. Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies. Int J Hyperth. 2018;34(8):1282–8. https://doi.org/10.1080/02656736.2017.1422557.

    Article  Google Scholar 

  50. Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22(02):300–6. https://doi.org/10.1200/JCO.2004.03.097.

    Article  PubMed  Google Scholar 

  51. Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, et al. Percutaneous image guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013;119(05):1033–104. https://doi.org/10.1002/cncr.27793.

    Article  PubMed  Google Scholar 

  52. Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116(04):989–97. https://doi.org/10.1002/cncr.24837.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Bagla S, Sayed D, Smirniotopoulos J, Brower J, Neal Rutledge J, Dick B, et al. Multicenter prospective clinical series evaluating radiofrequency ablation in the treatment of painful spine metastases. Cardiovasc Intervent Radiol. 2016;39(09):1289–97. https://doi.org/10.1007/s00270-016-1400-8.

    Article  PubMed  Google Scholar 

  54. Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skelet Radiol. 2019;48(8):1161–9. https://doi.org/10.1007/s00256-018-3140-0.

    Article  Google Scholar 

  55. Zugaro L, DI Staso M, Gravina GL, et al. Treatment of osteolytic solitary painful osseous metastases with radiofrequency ablation or cryoablation: a retrospective study by propensity analysis. Oncol Lett. 2016;11(03):1948–54. https://doi.org/10.3892/ol.2016.4108.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. Combined ablation and radiation therapy of spinal metastases: a novel multimodality treatment approach. Pain Physician. 2015;18(6):573–81.

    PubMed  Google Scholar 

  57. Kam NM, Maingard J, Kok HK, Ranatunga D, Brooks D, Torreggiani WC, et al. Combined vertebral augmentation and radiofrequency ablation in the Management of Spinal Metastases: an update. Curr Treat Options in Oncol. 2017;18(12):74. https://doi.org/10.1007/s11864-017-0516-7.

    Article  Google Scholar 

  58. • Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, et al. A feasibility study of percutaneous Radiofrequency Ablation followed by Radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol. 2011;21(9):2004–10. https://doi.org/10.1007/s00330-011-2133-3 Feasibility study reporting significantly better results concerning pain reduction when combined approaches (Radiotherapy and ablation) are applied.

    Article  PubMed  Google Scholar 

  59. Di Staso M, Gravina GL, Zugaro L, Bonfili P, Gregori L, Franzese P, et al. Treatment of solitary painful osseous metastases with radiotherapy, Cryoablation or combined therapy: propensity matching analysis in 175 patients. PLoS One. 2015;10(6):e0129021. https://doi.org/10.1371/journal.pone.0129021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Athens, Greece

    Dimitrios K. Filippiadis & Alexis Kelekis

  2. Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Steven Yevich

  3. Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France

    Frederic Deschamps

  4. Department of Musculoskeletal Radiology, Washington University School of Medicine, St Louis, MO, USA

    Jack W. Jennings

  5. Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Wauwatosa, WI, USA

    Sean Tutton

Authors
  1. Dimitrios K. Filippiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven Yevich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frederic Deschamps
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jack W. Jennings
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sean Tutton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexis Kelekis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios K. Filippiadis.

Ethics declarations

Conflict of Interest

Dimitrios K. Filippiadis declares that he has no conflict of interest.

Steven Yevich declares that he has no conflict of interest.

Frederic Deschamps declares that he has no conflict of interest.

Jack W. Jennings has received compensation from Merit Pharmaceuticals, Medtronic, and BTG plc for service as a consultant.

Sean Tutton declares that he has no conflict of interest.

Alexis Kelekis declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Palliative Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Filippiadis, D.K., Yevich, S., Deschamps, F. et al. The Role of Ablation in Cancer Pain Relief. Curr Oncol Rep 21, 105 (2019). https://doi.org/10.1007/s11912-019-0844-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-019-0844-9

Keywords

Search

Navigation