Abstract
BACKGROUND: Radiofrequency ablation (RFA) has gained attention as a palliative treatment for bone metastases, providing pain relief and local tumor control. While its use for axial lesions is well documented, its application in long bones remains limited due to concerns about post-ablation fractures. These risks may be mitigated through the combination of RFA with prophylactic intramedullary nailing (IMN). METHODS: Five consecutive patients with femoral metastases who underwent combined RFA and IMN, performed either as a single-stage procedure under intraoperative fluoroscopic guidance or as a two-stage procedure involving CT-guided RFA followed by IMN, were included. Pain relief, function, radiographic response, histology, and complications were retrospectively assessed. RESULTS: All patients experienced early pain relief and regained mobility. The mean intraoperative blood loss was 48 mL, which was statistically significantly lower than that in the historical control cases (n = 8; unpaired two-tailed t-test). At final follow-up, one lesion showed slight progression, three remained stable, and one decreased in size. Complications included one case of nonunion requiring revision surgery and one second-degree skin burn related to electrode pad placement. While immediate pain relief was remarkable, the independent midterm effect of RFA was difficult to determine, as IMN fixation itself provides substantial analgesia and most patients also received postoperative radiotherapy. No additive adverse effects were observed when radiotherapy was combined with RFA. CONCLUSION: The combination of RFA and IMN appears to be a feasible and safe minimally invasive option for achieving local tumor control and restoring function in femoral metastases. Potential candidates include those with impending fractures preserving cortical continuity, avulsion fractures of the lesser trochanter, hypervascular tumors, or radiotherapy-resistant lesions. This approach may serve as a less invasive alternative to extensive resection in carefully selected patients.