Analgesic efficacy and safety of percutaneous thermal ablation plus cementoplasty for painful bone metastases: a systematic review and meta-analysis

To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases.

We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed.

Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26–7.95, I² = 89%), 3.30 (95% CI, 2.25–4.82, I² = 98%), 2.58 (95% CI, 1.99–3.35, I² = 94%), 2.02 (95% CI, 1.50–2.71, I² = 93%), 1.78 (95% CI, 1.26–2.53, I² = 95%), and 1.62 (95% CI, 1.14–2.31, I² = 88%), and in the subgroup, 7.97 (95% CI, 7.45–8.52, I² = 86%), 3.01 (95% CI, 1.43–6.33, I² = 98%), 2.95 (95% CI, 1.93–4.51, I² = 95%), 2.34 (95% CI, 1.82–3.01, I² = 68%), 2.18 (95% CI, 1.57–3.03, I² = 78%), and 2.01 (95% CI, 1.16–3.48, I² = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2–6%, I² = 2%).

The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction.