OBJECTIVES:

To conduct a systematic review of the efficacy and safety of radiofrequency ablation (RFA) in patients with spinal metastases, explore differences in efficacy by prior treatment and primary tumour location and assess impact of RFA on health-related quality-of-life (HRQoL).

METHODS:

Searches for randomised controlled trials (RCTs) and non-randomised studies were conducted between March and April 2017 in the electronic databases EMBASE, Medline and CENTRAL and conference proceedings, for ASCO and ESMO published in the last two years.

RESULTS:

We identified 14 non-randomised (seven prospective and seven retrospective) studies that investigated RFA followed by cement augmentation in some or all patients. All but three studies (prospective interventional) were case series and no RCTs were identified. A significant decrease in pain outcome, measured by numerical rating scale (NRS) or visual analogue scale (VAS), was reported post-RFA compared to baseline in 10/13 studies assessing pain. Pain improved significantly at 1 week versus baseline, measured by NRS (5.9 to 3.5, p<0.0001; 8 to 4.3, p<0.02 and 8 to 3.9, p<0.0001) and VAS (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p<0.0001; 7.82 to 2.82, p<0.001) and improvement was maintained at 1 month post-RFA. Few procedural complications were reported. Pain outcomes reported in two studies indicate prior therapy had little impact on the efficacy of RFA. Data by primary tumour location in two studies show higher rates of recurrence of breast, pancreatic, renal and thyroid cancer compared to other cancers over the 5-year period. A study measuring HRQoL of patients with FACT-G and FACT-bone pain suggest a significant improvement (p<0.0001) in both scores post-RFA compared to baseline.

CONCLUSIONS:

Our findings indicate a clinical benefit in patients with spinal metastases treated with RFA with respect to subjective pain measures with limited safety implications. Controlled studies are required to provide more robust evidence of the clinical efficacy and safety of RFA.