Complications Following Percutaneous Image-guided Radiofrequency Ablation of Bone Tumors: A 10-year Dual-Center Experience

Background: Percutaneous radiofrequency ablation (RFA) is effective in the management of bone tumors. However, knowledge of the complication rate and risk factors for complications of RFA is lacking. Purpose: To report the complication rate and risk factors of bone tumor RFA. Materials and Methods: This retrospective study reviewed complications in consecutive patients who underwent RFA of primary or metastatic bone tumors from January 2008 to April 2018. Complications were categorized into major (grade 3 or 4, severe or life-threatening) or minor (grade 1 or 2, mild or moderate) according to Common Terminology Criteria for Adverse Events. Univariable and multivariable regression analyses were performed to identify variables associated with complications of RFA. Results: A total of 169 patients (median age, 63 years; interquartile range, 55-73 years; 85 men) with 217 tumors were evaluated. The total complication rate was 30.0% (65 of 217; 95% confidence interval [CI]: 23.8%, 36.0%). The major complication rate was 2.3% (five of 217; 95% CI: 0.8%, 5.3%), with secondary fracture being the most frequent event (1.8% [four of 217]). The minor complication rate was 27.7% (60 of 217; 95% CI: 21.7%, 33.6%), with immediate postoperative pain being the most frequent event (18.0% [39 of 217]). Risk factors for all complications included tumor size greater than 3 cm (adjusted odds ratio [AOR], 2.4 [95% CI: 1.2, 4.5]; P =.03) and previous radiation therapy (AOR, 3.8 [95% CI: 2.0, 7.4]; P =.02). The only risk factor for minor complications was previous radiation therapy (AOR, 2.2 [95% CI: 1.0, 4.7]; P =.04). Conclusion: Bone tumor radiofrequency ablation is safe, with a low rate of major complications mainly consistent with secondary fractures. Risk factors for complications are tumor size greater than 3 cm and previous radiation therapy. (C) RSNA, 2020