Radiofrequency Ablation Safe and Effective for Reducing Pain From Bone Metastases

Image-guided radiofrequency ablation (RFA), a minimally invasive cancer treatment performed in outpatient settings, significantly reduced the level of pain in cancer patients with bone (osseous) metastases. This pain reduction limited the need for strong narcotic pain management and improved patient frame of mind, according to results of an American College of Radiology Imaging Network (ACRIN) study published online in the journal Cancer.

Each year in the United States, more than a million new cancer cases are diagnosed. Between 30 percent and 70 percent of these patients will develop a painful bone metastasis. Current pain treatments are not always effective. Many patients require increasing doses of narcotics to manage pain. RFA is an image-guided technology that uses heat to kill, or ablate, tumor cells. This study, sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), demonstrated that RFA is a safe and effective pain management tool for patients with bone metastases. RFA is often used to treat liver, kidney, and lung cancer tumors.

“It is clear that improved palliative treatments must be identified to address the needs of these great many patients,” says Damian Dupuy, MD, principal investigator of the study and director of ablation services at Providence-based Rhode Island Hospital.

The researchers studied 55 patients who had a painful bone metastasis. Each subject received CT-guided RFA of the tumor. Patients evaluated their pain prior to treatment, then daily for two weeks, and again at one month and three months after RFA. The study results showed statistically significant pain reduction at the one- and three-month follow-ups for all pain assessment measurements: pain relief, intensity, and severity. In all cases, researchers saw improvement for each measurement, including patient mood.

“We know that RFA is a highly effective cancer treatment when surgery is not an option. RFA offers potential advantages over other methods in that cell death is immediate, lesion size can be accurately controlled, lesion temperature can be monitored, and it can be performed under local anesthesia and conscious sedation in the outpatient setting. This is a significant step forward in the pain management of these patients,” says Dr. Dupuy, who is also professor of diagnostic imaging at The Warren Alpert Medical School of Brown University in Providence.

The procedure was found to be safe with few adverse events. RFA can be an alternative for patients who previously received radiation therapy and have reached their maximum radiation dose, but are still experiencing pain.

“Despite advances in radiation technology and development of new medical manipulations, too many cancer patients still experience pain associated with their disease,” says Thomas DiPetrillo, MD, clinical director of radiation oncology at Rhode Island Hospital and associate professor of radiation oncology at The Warren Alpert Medical School of Brown University. “This study demonstrates the palliative benefits of RFA with minimal treatment-related morbidity.”

– American College of Radiology



New Brain Scan Detects Earliest Signs of Alzheimer’s Disease in Healthy People

Diffusion tensor imaging (DTI), a new type of brain scan, may be better at detecting if a person with memory loss might have brain changes of Alzheimer’s disease, according to a new study published in an online issue of Neurology®.

“As better medicines for Alzheimer’s disease become available, it will be important to identify people at high risk for the disease as early and accurately as possible so treatment can be most effective,” says the study’s author, Norbert Schuff, PhD, with the University of California School of Medicine and the Veterans Affairs Medical Center, San Francisco.

For the study, 76 healthy people in Rome between the ages of 20 to 80 underwent DTI-MRI brain scanning, which is more sensitive than traditional MRI for detecting changes in brain chemistry, thereby mapping fiber tracts that connect brain regions. The researchers examined DTI changes in the hippocampus, the brain region critical to memory and one that is involved in Alzheimer’s disease.

Participants were given verbal tests and tests that measured visual perception of space between objects. Scientists compared the brain scans and found that changes in DTI imaging better explained declines in memory compared with hippocampus volume through a traditional MRI. They found that mean diffusivity in the hippocampus better predicted verbal and spatial memory performance in the participants, especially in those who were over 50.

“Our findings show this type of brain scan appears to be a better way to measure how healthy the brain is in people who are experiencing memory loss. This might help doctors when trying to differentiate between normal aging and diseases like Alzheimer’s,” says study author Giovanni Carlesimo, PhD, with Tor Vergata University in Rome, Italy. “DTI, along with MRI, could serve as an important tool in understanding how and why a person experiences memory decline.”

– American Academy of Neurology

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