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What is Bone Tumor Ablation?

Ablation is a treatment to destroy cancerous cells or tumors. Bone tumor ablation is a minimally invasive surgical technique that employs heat or cold energy to treat bone tumors without traditional surgery. The technique uses image guidance such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scan to pass a needle or probe through the skin into the bone tumor to destroy the tumor cells instead of surgically removing the tumor.

Some of the approaches employed in bone tumor ablation include:

  • Radiofrequency ablation (RFA): This is one of the most common methods of ablation in which a needle or probe is passed through the skin into the bone tumor and high-frequency electrical currents are transmitted via probe or electrode in the needle to heat the tumor and destroy the cancerous cells.
  • Microwave ablation (MWA): This method is similar to RFA and employs energy from electromagnetic waves or microwaves to heat and destroy the bone tumor with a probe.
  • Cryoablation (cryotherapy): In this method, a thin metal probe is guided into the bone tumor and extremely cold temperatures are transmitted via the probe to freeze the tumor and cause the cancerous cells to die.
  • MRI-guided Focused Ultrasound (MRgFUS): This is an advanced thermal ablation technique that is completely non-invasive: no skin break is made and no instrument is introduced into the body. The technique involves delivering a string of targeted ultrasonic pulses on the site of the tumor within the bone to heat and destroy the cancer cells.

Indications of Bone Tumor Ablation

Some of the indications for bone tumor ablation to treat bone tumors include:

  • The tumors are small, measuring less than 5 cm in diameter
  • You are not fit enough to have a surgical excision of the tumor or may have difficulty with surgery
  • You have preexisting medical conditions that make surgery risky
  • You are older and cannot go through traditional surgery or postsurgical recovery
  • As a palliative treatment to relieve pain
  • To decrease the size of the tumor to eliminate it more easily with radiation therapy or chemotherapy

Preparation for Bone Tumor Ablation

Pre-procedure preparation for bone tumor ablation will involve the following steps:

  • A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to the procedure.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • Women should always notify their doctor if they are pregnant or suspect to be pregnant.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for some days prior to surgery.
  • You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You may be instructed to shower with an antibacterial soap on the morning prior to surgery to reduce the risk of infection.
  • Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure Involved in Bone Tumor Ablation

The procedure is performed by an interventional radiologist mostly in an outpatient setting under general anesthesia or local anesthesia to numb the treatment area. A nurse will attach an intravenous line for delivery of medications and fluids and connect monitoring devices to the body to measure blood pressure, heart rate, pulse, and oxygen level during the procedure. Your interventional radiologist then uses an ultrasound scan or a CT scan as guidance to insert a probe or special needle via your skin into the site of the tumor to destroy the cancerous cells. This process may need to be repeated depending on the tissue size, location, and number to ensure all tumors are destroyed. Your interventional radiologist will withdraw the probe once the treatment is complete and cover the treatment area with a bandage. The procedure usually takes about one to three hours.

Postoperative Care and Recovery Involved in Bone Tumor Ablation

In general, bone tumor ablation will involve the following postoperative care instructions:

  • You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
  • Your nurse will monitor your vital signs and observe you for any allergic or anesthetic reactions as you recover.
  • Most individuals are able to walk, eat, and drink within a couple of hours post ablation procedure.
  • You will likely be discharged the same day once stable; however, some may require an overnight stay.
  • You may experience some pain, swelling, and discomfort in the treatment area. Pain and anti-inflammatory medications and cold packs are recommended as needed.
  • Your physician will also provide you with antibiotics to prevent infection.
  • Refrain from smoking for a specific period of time as this may hamper proper healing.
  • You should be able to resume all your normal activities within a few days; however, you may need to take off work for a week to recover and promote healing.
  • Refrain from strenuous activities and lifting heavy weights for the first few weeks. Gradual increase in activities over a period of time is recommended.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Bone Tumor Ablation

Some of the benefits of bone tumor ablation include:

  • Less expensive than other forms of treatment
  • Comparatively quick procedure with fast recovery
  • Minimal complications and discomfort with a shorter hospital stay
  • No surgical incision is required, just a small nick on the skin or not even that if MRgFUS ablation method is used
  • Works as a combination therapy with radiotherapy or chemotherapy
  • As it is a minimally invasive/non-invasive therapy, it may be employed repeatedly to treat recurrent bone tumors

Risks and Complications of Bone Tumor Ablation

Bone tumor ablation is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Damage to nerves, vessels, and body parts
  • Post-procedure pain, requiring narcotics for relief
  • Anesthetic reactions