National Bone Tumour Ablation Centre

Year on year, the number of patients in Ireland presenting with bony metastatic disease is exponentially increasing, with associated patient morbidity. Between 1994 and 2012, 14,995 cases of bony metastatic disease were recorded. Traditionally regarded as an untreatable disease, new therapies and interventions, specifically ablation techniques, now offer options to successfully treat affected patients.

To support the already established National Sarcoma Service, which bridges St Vincent’s University Hospital and the National Orthopaedic Hospital Cappagh (NOHC), we are establishing the new National Bone Tumour Ablation Unit to support existing orthopaedic services.

The new unit, supported by 4 dedicated musculoskeletal radiologists and anaesthetists, employs image guidance provided by CT and general anaesthesia to allow precision placement of therapy catheters employing super cooling, cryotechnique, or super heat in the form of radiofrequency or microwave to ablate tumour deposits and stabilise treated areas by percutaneous injection of polymethyl methacrylate (PMMA), with or without additional orthopaedic hardware fixation.

While many patients with bony metastatic disease are treated by chemotherapy and radiotherapy alone, increasing numbers of patients with specific, often solitary, bone metastatic deposits are being recognised and deemed suitable for treatment by ablation techniques.

Traditionally, attempts to treat these patients in regional units have been hindered by limited access to imaging or a lack of professional expertise and the necessary equipment.

By providing a dedicated unit, patients will have timely access to treatment, performed with image guidance using green anaesthetic total intravenous anaesthesia (TIVA) techniques, and will undergo day bed recovery before being transferred back to regional parent hospitals or directly home.

A subgroup of patients with osteoid osteomas represents a specific target. These tumours, predominantly identified in developing bone in patients between 10 and 30 years, occur throughout the skeleton and are a cause of excruciating constant pain for those affected. Occurring in between 30 and 40 patients annually in Ireland, these tumours can be cured by a single ablation treatment guided by CT scanning. Providing a dedicated unit to treat these lesions in Ireland will obviate referral to European centres for costly treatments.