Osteoid Osteoma

Background

Outside Approval SquareAn osteoid osteoma is a small benign bone tumor that is found most commonly in the vertebra and long bones, such as the femur and tibia. It consists of a nidus, or a core of growing cells, surrounded by a thick bony shell.

Patients with osteoid osteoma experience pain that worsens at night. The cause of osteoid osteomas is not known. Osteoid osteomas affect anywhere from 10 to 40 individuals per 100,000, comprising 12% of benign bone tumors and 3% of all bone tumors. They are three times more common in males than in females, and the majority are found in children and adults up to 24 years old.

Clinical Trials Square

Current Treatment

In many cases, osteoid osteomas disappear within 3 years, and the pain associated with them can be managed with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. For cases where pain is severe or does not respond to NSAIDs, treatment options include surgery and radiofrequency ablation.

Focused Ultrasound Treatment

Focused ultrasound has the potential to offer a completely noninvasive method of ablation. Instead of making an incision and inserting probes, the physician, guided by ultrasound or magnetic resonance imaging, directs a focused beam of acoustic energy toward the nidus. This beam heats and destroys the osteoid osteoma without
damaging nearby tissues or structures.

As a potentially noninvasive treatment, focused ultrasound may offer benefits including:

  • more precise targeting of the nidus by ultrasound or magnetic resonance imaging, reducing the risk for damage to surrounding bone and tissue;
  • shorter treatment duration;
  • lower risk for complications such as infection; and
  • shorter recovery time, with the patient often returning to work and other activities the following day.

Clinical Trials

A study assessing MR-guided focused ultrasound to treat osteoid osteoma is ongoing at The Hospital for Sick Children (SickKids) in Toronto, Canada. The first patient was treated in July and experienced a significant reduction in his pain, according to a press release from SickKids. The study, funded in part by the Foundation, will ultimately enroll more patients at additional sites worldwide. For more information, contact James M Drake, FRCSC, FACS (416-813-6125 or ) or Maria Lamberti-Pasculli, RN (416-813-6456 or ).

A clinical trial for patients with clinical and imaging diagnosis of non-spinal osteoid osteoma is currently being conducted at the Sapienza University of Rome. For further information, contact: Alessandro Napoli, MD, PhD at  or +390649974540

There is a trial ongoing at Children's National Medical Center in Washington, DC. For more information, contact Amanda Mahoney, MA at 202-476-2263 or .

Treatment Sites

Please see here for a list of treatment sites.

Regulatory Approval and Reimbursement

The ExAblate focused ultrasound system manufactured by InSightec is approved in Europe for the treatment of osteoid osteoma. 

To date, focused ultrasound is not universally reimbursed by medical insurers for treatment of osteoid osteoma.

Notable Papers

Rovella MS, Martins GL, Cavalcanti CF, Bor-Seng-Shu E, Camargo OP, Cerri GG, Menezes MR. Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Osteoid Osteoma: A Case Series Report. Ultrasound Med Biol. 2016 Apr;42(4):919-23. doi: 10.1016/j.ultrasmedbio.2015.11.003. Epub 2016 Jan 16.

Masciocchi C, Zugaro L, Arrigoni F, Gravina GL, Mariani S, La Marra A, Zoccali C, Flamini S, Barile A. Radiofrequency ablation versus magnetic resonance guided focused ultrasound surgery for minimally invasive treatment of osteoid osteoma: a propensity score matching study. Eur Radiol. 2015 Nov 26.

Filippiadis DK, Tutton S, Mazioti A, Kelekis A. Percutaneous image-guided ablation of bone and soft tissue tumours: a review of available techniques and protective measures. Insights Imaging. 2014 Jun;5(3):339-46. doi: 10.1007/s13244-014-0332-6. Epub 2014 May 17.

Geiger D, Napoli A, Conchiglia A, Gregori LM, Arrigoni F, Bazzocchi A, Busacca M, Moreschini O, Mastantuono M, Albisinni U, Masciocchi C, Catalano C. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. J Bone Joint Surg Am. 2014 May 7;96(9):743-51. doi: 10.2106/JBJS.M.00903.

Napoli A, Mastantuono M, Cavallo Marincola B, Anzidei M, Zaccagna F, Moreschini O, Passariello R, Catalano C. Osteoid osteoma: MR-guided focused ultrasound for entirely non-invasive treatment. Radiology. 2013 May;267(2):514-21.

Click here for additional references from PubMed.

Animated treatment video courtesy of Insightec.

     

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