Percutaneous cryoablation of musculoskeletal tumours: the largest reported single-centre case series — outcomes, complications and subgroup analysis

OBJECTIVES: Cryoablation is an image-guided, minimally invasive treatment technique that uses extreme cold to induce tumour destruction. Its role in musculoskeletal oncology has expanded in recent years, although large clinical series remain limited. This study reports a large single-centre experience of percutaneous cryoablation for musculoskeletal tumours, including metastatic lesions, benign and cartilaginous tumours, and primary bone tumours. MATERIALS AND METHODS: This was a single-centre retrospective cohort study conducted at a tertiary musculoskeletal oncology centre. All procedures were performed by a single specialist musculoskeletal interventional radiologist with over 20 years of experience. The study included patients who underwent percutaneous cryoablation for musculoskeletal tumours between June 2021 and December 2025. Clinical response, radiological response, recurrence, and complications were assessed over a median follow-up of 3 months (mean 8.7 months; range 0-48 months). Radiological response was assessed using pre-treatment and post-treatment Hounsfield Unit (HU) measurements on CT; this is not a validated radiological scoring system and is reported as a complementary, exploratory marker alongside standard clinical response assessment. Complications were graded using the CIRSE classification system. RESULTS: A total of 48 patients underwent percutaneous cryoablation during the study period. The cohort included 26 males and 22 females, with a median age of 40 years. A good or complete response was achieved in 28 patients, representing 58% of the total cohort. A partial response was achieved in seven patients, representing 15% of the total cohort. HU reduction was observed in 45 of 48 patients, representing 94% of the cohort. The overall complication rate was 6.3%, with three complications recorded among 48 procedures. No major complications or procedure-related deaths were observed. CONCLUSIONS: Cryoablation appears to be a safe and effective minimally invasive treatment for selected musculoskeletal tumours. Most patients achieved a good, complete, or partial response, with a low complication rate. Hounsfield Unit reduction after treatment may provide a useful, though as yet non-validated, marker of radiological response. Further prospective studies with longer follow-up, standardised response criteria and validated complication grading are needed to confirm these findings.