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Brücken bauen – von der Evidenz zum Patientenwohl: 19. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

08.03. - 10.03.2018, Graz

Radiofrequency ablation as a palliative pain treatment in patients with vertebral metastases: a systematic review

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  • author presenting/speaker Katharina Rosian - Ludwig Boltzmann Institut für Health Technology Assessment
  • Katharina Hawlik - Ludwig Boltzmann Institut für Health Technology Assessment
  • Brigitte Piso - Ludwig Boltzmann Institut für Health Technology Assessment

Brücken bauen – von der Evidenz zum Patientenwohl. 19. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Graz, Österreich, 08.-10.03.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18ebmP7-7

doi: 10.3205/18ebm133, urn:nbn:de:0183-18ebm1339

Published: March 6, 2018

© 2018 Rosian et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Purpose: Many tumour patients develop painful vertebral metastases in the course of their disease that destroy the vertebrae and often do not adequately respond to standard therapies. Metastatic spinal lesions are difficult-to-treat entities that most commonly are associated with pain and severely reduced health-related quality of life (HRQoL). Radiofrequency ablation (RFA) has arisen as an option in the palliative treatment of vertebral metastases within the last years. Our review aims at evaluating the clinical effectiveness and safety of RFA in patients with painful vertebral metastases.

Materials and methods: A systematic literature search was performed in five databases and completed by a manual search. The review applied a methodological framework based on the HTA Core Model®, developed within EUnetHTA (European Network for Health Technology Assessment). Data on each selected outcome category were synthesised according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) scheme. Risk of bias was assessed with the IHE (Institute of Health Economics) Risk of Bias checklist for case series.

Results: 299 citations were identified. After applying the inclusion criteria, a total of nine studies (four prospective and five retrospective studies) were chosen for eligibility. The studies included a total of 583 patients with vertebral metastases who were treated with RFA and, in most cases, an additional vertebroplasty treatment was performed (n=437). The studies were categorised with a moderate to high risk of bias. The strength of evidence is “very low” for safety outcomes and could not be assessed for efficacy outcomes. Current evidence suggests that RFA leads to a significant pain reduction. Furthermore, no major complications occurred when using RFA.

Conclusion: According to the available evidence RFA is likely to be safe and effective, especially for patients with painful vertebral metastases who show contraindications or unresponsiveness to conventional therapies (e.g., radiation) or for those who are at risk of tumour progression. Thus, on ethical grounds, every therapy providing pain relief and causes no major complications may be justified. According to the available evidence it seems that RFA, most commonly used in combination with vertebroplasty, is a safe and effective treatment option to palliate pain.