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Painful skeletal metastases are a common problem in patients with cancer. Autopsy studies have shown up to 85% of patients who die from breast, prostate, and lung cancer have evidence of bone metastases at the time of death (). Skeletal metastases often result in complications such as pain, fractures, and decreased mobility that adversely affect a patient’s quality of life, and ultimately reduce performance status. In addition, these complications can affect a patient’s mood and lead to associated depression and anxiety (, ). Current treatment for patients with bone metastases is primarily palliative and includes the following: localized therapies (radiation and surgery), systemic therapies (chemotherapy, hormonal therapy, radiopharmaceuticals, and bisphosphonates), and analgesics (opioids and nonsteroidal antiinflammatory drugs).

Percutaneous radiofrequency treatment of osteoid osteoma has been performed for more than 10 years. It is the preferred method of treatment for most patients in those centers that offer it, and has been shown to be a safe, effective, and cost-effective alternative to operative treatment (1–5). However, many patients continue to be subjected to the increased risks and lengthy recovery of open surgery or to the prolonged discomfort and risks associated with medical therapy. This is presumably because of lack of awareness of the technique or benefits of percutaneous treatment. This chapter provides a detailed description of proper patient selection, technique, and follow-up for those wishing to perform this therapy.

The treatment of prostate cancer remains a significant dilemma. The prevalence of prostate cancer is quite high, documented by pathologic studies. It is well accepted that a major proportion of prostate cancers will not be clinically significant (1). Even those cancers with a volume of 0.5 cc or greater have a variable biologic behavior. On the other hand, the treatments for prostate cancer are not without substantial chance for lifestyle-limiting morbidity. Recent information showing minimal survival benefit between no treatment and radical prostatectomy has emphasized the concept of “watchful waiting”; that is, not treating the primary tumor at all has gained acceptance as a viable management alternative in certain patient populations (2). The decision to treat an individual’s prostate cancer with a particular therapy or at all, requires a careful assessment of the risk versus benefit for that patient. As the complications and lifestyle limiting side effects of treatments are reduced, these decisions become easier. The reintroduction of ultrasound-guided prostate cryotherapy is founded on the goal of decreasing the morbidity of prostate cancer treatment.

Embolization of the uterine arteries has been the standard of care for management of acute bleeding after childbirth or after gynecologic surgery since the late 1970s (,). Through the 1980s, apparently no one in either the interventional radiology or gynecologic communities had thought of treating uterine fibroids by embolization. This may have been due to the minimal interaction between interventional radiology and gynecology practices.

The use of cryoablation in the breast has been anecdotally investigated since the mid-1800s (). Recently, however, more concerted and structured research has been conducted that builds upon the modern understanding of cryobiology and several advances in technology.

The surgical management of breast cancer has evolved gradually over the past century from the exclusive use of radical mastectomy to the current practice of segmental mastectomy and radiation therapy. This less aggressive surgical approach in the management of breast cancer extended to treatment of the axilla. The latter led to the recent introduction and subsequent acceptance of lymphatic mapping and sentinel node biopsy as an alternative strategy to the routine use of formal levels I and II axillary dissection in clinically node-negative patients.

Percutaneous and surgical ablation procedures are flourishing, in large part because of the relative paucity and the acceptability of complications. However, serious and fatal complications have occurred, albeit rarely, with ablation. This chapter identifies those complications, describes their underlying cause, and, when possible, discusses strategies to avoid them.

Lung cancer is the second most frequent cause of cancer in both men and women in the United States (). There were an estimated 91,800 lung cancer cases in men and 80,100 cases in women in the United States in 2003. The most effective treatment for patients with localized lung cancer is surgical resection. Radiation therapy and chemotherapy also are established effective treatments in patients with more advanced lung cancer. The role of tumor ablation in the management of patients with lung cancer is evolving. To understand the current and future potential role in the management of patients with lung cancer, it is important to have information about the available therapies for the different stages of lung cancer.

Surgical resection, radiation therapy, and systemic chemotherapy are the primary treatment modalities for patients with gastrointestinal malignancies. Ablative therapies such as radiofrequency ablation (RFA) and cryoablation hold potential as alternative treatment options that, in the appropriate setting, may be both efficacious and well tolerated. However, while ablative therapies are used commonly in the treatment of gastrointestinal malignancies, their precise role in such patients is poorly defined. Initial studies of ablative therapies have focused on malignancies such as colorectal cancer, hepatocellular carcinoma, and neuroendocrine tumors, in which surgical resection, particularly of metastatic lesions, has played an important role. Ablative therapies are less likely to play a significant role in the treatment of gastric and pancreatic cancer, which are more commonly associated with widespread dissemination and peritoneal disease.

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, especially in Taiwan, Japan, Korea, and China, as well as in sub-Saharan Africa (). This cancer has been increasing in the United States () and other countries ().