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Benign Osteoid Osteoma Pain Successfully Managed With Radiofrequency Ablation: Presented at SIR

By Ed Susman

WASHINGTON, DC -- March 24, 2008 -- Pain caused by symptomatic osteoid osteoma appears to be relieved in more than 90% of cases by treatment with radiofrequency ablation delivered through minimally invasive outpatient techniques.

Although conservative medical management of osteoid osteoma is now the standard course of treatment for these benign tumours, researchers suggested at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting that the procedure be elevated.

"Percutaneous radiofrequency ablation should be considered a first-line therapy for symptomatic osteoid osteoma," said Eran B. Hayeems, MD, Associate Professor of Medical Imaging and Assistant Professor of Medicine, University of Toronto, Toronto, Ontario, Canada. "It is a minimally invasive, safe, and effective technique for treatment of these lesions."

Dr. Hayeems reviewed outcomes among 40 patients who underwent 42 computer-assisted tomography-guided procedures. Most people who develop osteoid osteoma are young men, and the group of patients in Toronto mirrored that -- 31 the of patients were men and the mean age of all patients was 25 years, although the ages ranged from 17 to 62 years.

Although not malignant, these tumours can cause meaningful complications for patients. The pain has been described as severe and sharp and is worse at night; if the tumours are in the long bones, growth abnormalities are possible.

Pain associated with these tumours responds to aspirin and other nonsteroidal anti-inflammatory drugs, but because the pain can last several years, adverse effects from these medications can make treatment problematic, Dr. Hayeems said in his featured poster presentation on March 18.

Dr. Hayeems and colleagues followed patients who underwent the percutaneous procedure from September 2004 to September 2007. He identified 36 patients with lower-extremity or pelvic lesions and 4 patients with upper-extremity or scapular lesions.

All 42 of the procedures appeared to be technically successful, with imaging scans showing ablation of the nidus of the lesion. Four patients were lost to follow-up. Of the rest, 92% of 36 the patients had clinical resolution of their pain postprocedure, Dr. Hayeems said.

Of the 3 patients whose pain did not resolve, 1 woman decided to have a repeat procedure and was pain free following the second procedure. One patient returned to the hospital 6 days later with a subcutaneous abscess that resolved with drainage and a course of antibiotics. One patient returned 2.5 years later when a new lesion developed. It was also eliminated with radiofrequency ablation.

"While imaging follow-up may not be necessary among patients with complete relief of pain," Dr. Hayeems said, "dynamic gadolinium-enhanced magnetic resonance imaging of the nidus can be helpful in those few patients who experience treatment failure for whatever technical reason. Identifying viable tissue in the nidus can help guide future ablation of those lesions."


[Presentation title: Clinical and Imaging Outcomes of Radiofrequency Ablation of Osteoid Osteoma. Abstract 327]

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