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Radiofreqency Ablation for Bone Tumors

Clinical evidence

A post-market study for
OsteoCool™ RF ablation

Indications, Safety, and WarningsImportant information on the OsteoCool™ RF ablation probe kitIndications for useThe OsteoCool™ RF ablation probe kit, in combination with other components of the OsteoCool™ RF ablation system, is intended for:

Palliative treatment in spinal procedures by ablation of metastatic malignant lesions in a vertebral body

Coagulation and ablation of tissue in bone during surgical procedures including palliation of pain associated with metastatic lesions involving bone in patients who have failed or are not candidates for standard therapy

Ablation of benign bone tumors such as osteoid osteoma

Contraindications

Use of the OsteoCool™ RF ablation system device is contraindicated in vertebral body levels C1-C7.

Warnings

The OsteoCool™ RF ablation probe kit contains single use devices. They should not be re-sterilized or re-used. Reuse can cause the patient injury and/or the communication of infectious disease(s) from one patient to another.

Take appropriate precautions for patients with blood coagulation disorders, anticoagulant use, neurological deficit, or systemic infection or local infection in area of the procedure.

The procedure is to be performed with minimal to moderate sedation to allow the patient to remain in a communicative state for patient feedback.

Adequate measures must be taken to minimize X-ray exposure while using fluoroscopy. This exposure can result in acute radiation injury as well as increased risk for somatic and genetic effects. Do not modify the equipment as this may compromise safety and efficacy.

When the OsteoCool™ RF generator is activated, electrical fields may interfere with other electrical medical equipment.

During power delivery, the patient should not be allowed to come in contact with grounded metal surfaces.

Discontinue use if inaccurate, erratic, or sluggish temperature readings are observed. Use of damaged equipment may cause patient injury.

For safe use of the OsteoCool™ RF ablation system, the physician should have specific training, experience, and through familiarity with the use and application of this product.

Do not ablate in painful osteoporotic vertebra without tumor.

Do not use the device in fractures due to prostatic cancer or other osteoblastic metastases to the spine.

Do not use the products in dense (sclerotic) bone including traumatic high energy fracture as device damage resulting in patient injury may occur.

Do not use this device in patients without metastatic malignant lesions in bone or in the vertebral body.

When using this device in the vertebral body, do not use this device in patients with multiple myeloma, solitary plasmacytoma, or primary malignant lesions in the index vertebra.

Do not use this device in more than one vertebral body.

Do not touch the electrode tip while power is being applied.

Do not withdraw the OsteoCool™ RF ablation probe while power is being applied to ablate lesions.

Use standard electrosurgical cautions when using the OsteoCool™ RF ablation system in the vicinity of nerves and nerve roots.

Ablation must be performed under fluoroscopic guidance. Do not perform ablation without imaging as it will result in severe injury to the patient.

When using this device in the vertebral body, the OsteoCool™ RF ablation probe must be positioned within the vertebral body such that when ablation is performed per the thermal distribution graphs, nerves and nerve roots are beyond the ablation zone. Failure to follow the thermal distribution graphs will result in severe injury to the patient.

Precautions during ablation near organ surface or near vasculature – due to the non-homogenous conduction and convection of heat in this anatomy, shapes of ablations performed on tissue that is near the organ surface or near vasculature may not be spherical. Careful planning should be done for targets that require ablation in these locations.

Any application or procedure that alters tissue perfusion and affects temperature elevation should be monitored carefully.

High power settings can cause local desiccation of tissue, which can impede the ability to produce expected ablations. Set power as low as possible for intended purpose. Follow manufacturer’s guidelines of time at temperature for ablation generation. If the recommended times and temperatures are not achieved there can be no assurance that the desired ablation volume has been created. Standard techniques for evaluation (e.g., CT or MRI) should be used to determine the actual extent of all ablations.

It is important to carefully evaluate all candidates for this procedure for evidence of impending fracture, particularly in weight-bearing bone. Do not perform RF ablation of metastases in weight-bearing bone with evidence of impending fracture. Note: Pathologic fracture is more prevalent and serious in long bone.

It is important to carefully evaluate all candidates for this procedure for proximity of the metastasis to critical structures. Ensure that device placement is at least 1 cm away from the structures not intended for ablation. Proximity to nerve structures is particularly critical. Serious complications such as incontinence can occur if these critical structures are damaged during the RF ablation procedure.

The durability of pain relief after using this device to ablate painful bone metastases has not been established.

Do not use in patients who have electronic implants such as cardiac pacemakers without first consulting a qualified professional (e.g., cardiologist). A possible hazard exists because interference with the action of the electronic implant may occur, or the implant may be damaged.

PrecautionsDo not attempt to use the OsteoCool™ RF ablation probe kit before thoroughly reading the accompanying instructions for use and the user manual for the OsteoCool™ RF generator.

Only physicians familiar with RF lesion techniques should use the OsteoCool™ RF ablation probe kit components.

Do not modify the kit components, including bending and removing insulation.

Use care when handling the devices.

Proper sterile techniques must be used when assembling and filling the OsteoCool™ tube kit. Do not place the lid down on a non-sterile surface.

OsteoCool™ RF ablation probe

The OsteoCool™ tube kit should never be disconnected from the OsteoCool™ RF ablation probe when RF delivery is in progress. The lumen of the tube kit should not be obstructed in any way during the procedure, as this will stop cooling of the probe.

Disconnect the OsteoCool™ RF ablation probe by pulling the connector, not the cable.

Handle the OsteoCool™ RF ablation probe safely when it is in use due to electric currents and the hot tip.

Do not bend the OsteoCool™ RF ablation probe as this may damage the insulation.

Do not remove or withdraw the OsteoCool™ RF ablation probe while energy is being delivered to ablate lesions.

While inserting the OsteoCool™ RF ablation probe through the introducer watch the fluoroscope for any buckling. Do not attempt to further insert the probe if any buckling is observed or significant resistance is felt.

Do not move the introducer when the OsteoCool™ RF ablation probe is in it. If repositioning is needed, retract the probe from the introducer and then reposition the introducer with the stylet inserted.

The physician must determine, assess, and communicate to each individual patient all foreseeable risks of the RF procedure.

The temperature displayed on the generator while in “Ablate” refers to the cooled electrode temperature and not the hottest tissue temperature.

Introducer (not supplied)Introducers must be 13 Gauge or larger, and have a length such that the proximal electrode on the probe is extended at least 5 mm beyond the distal margin of the introducer.OsteoCool tube kit

The OsteoCool™ tube kit is for use with a single OsteoCool™ RF ablation probe.

Care must be taken to ensure all luer fittings are secure to prevent leaking. Do not disconnect luer fittings while the pump is running.

Arrange equipment to minimize tubing tripping hazards.

Do not complete cooled RF lesion procedures if water is not circulating through the tube kit, water is leaking, or air bubbles are seen in the tubing. Immediately stop the procedure and correct circulation before restarting the procedure.

Do not pinch the tubing of the OsteoCool™ tube kit.

Adverse eventsThe OsteoCool™ RF ablation probe kit is used with other components of the OsteoCool™ RF ablation system in RF lesion procedures. Adverse events associated with the use of this device are similar to those indicated for medicated and anesthetic methods utilized in other surgical procedures.

As a consequence of electrosurgery, damage to surrounding tissue through iatrogenic injury could occur

Nerve injury including thermal injury, puncture of the spinal cord or nerve roots potentially results in radiculopathy, paresis, and paralysis

Pulmonary embolism

Hemothorax or pneumothorax

Infection including deep or superficial would infection

Unintended puncture wound including vascular puncture and dural tear

Hemorrhage

Hematoma

Pain

Patient selection criteriaCandidates suitable for RF ablation procedures with the OsteoCool™ RF ablation system include:

Patients experiencing significant pain from metastases involving bone

Patients with localized pain resulting from not more than two sites of metastatic disease

Patients that do not have evidence of impending fracture

Patients should be examined prior to the RF ablation procedure to determine the focal site(s) of pain. The following should be used to help guide therapy and define the area that is intended for RF ablation:

Location of most significant pain

Pre-operative image scans to correlate with the patient physical exam and patient symptoms

The extent of bone surrounding the tumor(s) to aid in selecting ablation parameters

The size, shape, and location of the metastatic lesion in the patient will determine the number of ablations required.Per the indications for use, the device is intended for:

Palliative treatment in spinal procedures by ablation of metastatic malignant lesions in a vertebral body

Coagulation and ablation of tissue in bone during surgical procedures including palliation of pain associated with metastatic lesions involving bone in patients who have failed or are not candidates for standard therapy

Standard therapy is defined per relevant medical society guidelines on treatment of metastatic lesions involving bone. For guidance, please refer to applicable medical society guidelines.

New OPuS One clinical results

OPus One 12 month study results demonstrated pain relief and improvement of quality of life^1-3

Outcomes in 206 patients treated with OsteoCool™ RF ablations was:

Swift

3 days post-procedure

Significant

improvements at all visits

Sustained

through 12 months

OPuS One: Outcomes from 206 patients treated with up to 12 months follow-up.

OPuS One summary (open in new window)

OPuS One: Published primary manuscript from first 100 patients treated.

Download publication (open in new window)

Study design

The OsteoCool Post-Market Study, “OPuS One,” is a prospective multicenter study in the United States, Europe, and Canada. The goal of the study is to collect real-world outcomes on effectiveness and safety among a cohort of patients who have been treated with the OsteoCool™ RF ablation system.

Objectives of the 12-month analysis:

To characterize change in pain scores and quality of life from baseline through 12 months in patients with metastatic bone lesions of the spine.

Measurements:

Pain
Function
Quality of life
Medication

Post procedure follow-up:

3 days
1 week
1-, 3-, 6-, and 12- months

Additional study details (open in new window)

Levy J, Hopkins T, Morris J, et al. Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients. J Vasc Interv Radiol 2020; 31:1745–1752. https://doi.org/10.1016/j.jvir.2020.07.014
Levy J, David E, Hopkins T, et al. Radiofrequency Ablation for the Palliative Treatment of Osseous Metastases: Final Results from a Multicenter Study (OPuS One). Abstract at Society for Interventional Radiology Annual Scientific Meeting 2021.
Levy J, David E, Hopkins T, et al. Improvement In Quality Of Life In Patients Treated For Painful Osseous Metastases With Radiofrequency Ablation: The Opus One Study. Abstract at Society for Interventional Radiology Annual Scientific Meeting 2021.

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