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Anamnese und klinischer Befund: Eine 46-jahrige Patientin stellte sich mit seit 8 Wochen zunehmenden, morphinresistenten, zur Immobilitat fuhrenden Schmerzen im Bereich des rechten Sitzbeins vor. Nach intensiver und kompliaktionsreicher Vorbehandlung eines Ovarial- und Rektumkarzinom inklusive einer Beckenvorbestrahlung bis zu einer Herddosis von 70,4 Gy lehnte die Patientin eine erneute Operation, Strahlentherapie oder Chemotherapie ab. Untersuchungen: Die Knochenszintigraphie ergab eine Mehranreicherung im rechten Sitzbein. Das konventionelle Rontgen zeigte hier eine 3 × 4 cm grose Auftreibung mit Kortikalisausloschung. Die Computertomographie wies zahlreiche Mikrofrakturen und pseudarthrotische Veranderungen nach. Per Nadelbiopsie wurde eine Knochenmetastase des Rektumkarzinoms verifiziert. Die Prufung der Vorbestrahlungsfelder ergab ein hohes Risiko fur einen Bestrahlungsschaden bei konventioneller Fraktionierung. Therapie und Verlauf: Im interdisziplinaren Konsens erfolgte bei eingeschrankter Einsatzmoglichkeit von Standardverfahren eine perkutane Radiofrequenzablation mit nachfolgender Knochenzementauffullung. Der Eingriff wurde komplikationslos in einer Sitzung unter Analgosedierung und computertomographischer Nadelpositionierung durchgefuhrt. Nach 8 Tagen konnte die Patientin unter Morphinreduktion schmerzfrei mobilisiert entlassen werden, der Karnofsky-Index stieg von 30 % auf 90 %. Nach 9 Monaten anhaltender Schmerzfreiheit und Belastungsstabilitat traten neu Lungenmetastasen auf. Die Sitzbeinmetastase zeigte nativradiologisch keinen Tumorprogress, die Lage des Knochenzements war unverandert regelrecht. Einer erneuten Chemotherapie stimmte die Patientin jetzt zu. Folgerung: Die perkutane, kombinierte Radiofrequenzablation und Osteoplastie fuhrt im Einzelfall zur schnellen Wiederherstellung von Lebensqualitat und Mobilitat. Nutzen und Risiko der palliativen, minimal-invasiven Lokaltherapie von symtomatischen Knochenmetastasen sollten durch Studien objektiviert werden, speziell fur Patienten, bei denen Standardverfahren wie Strahlentherapie oder Operation ausscheiden oder versagen. History and admission findings: A 46-year-old woman presented with worsening, morhine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarial cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experiended several complications. The pelvic region had radiotherapy up to 70,4 Gy. Investigation: Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 × 4 cm in size. Computed tomography revealed numerous microfractures and pseudoarthrotic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation. Treatment and course: After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermoablated by using radiofrequency percutanously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasisis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumorprogress or dislocated bone cement. The patient now agreed to further chemotherapy. Conclusion: Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examing quality of life, especially in patients without the options of surgical and radiotherapy.

Endoscopy is well established as the primary approach in cases of severe acute upper gastrointestinal bleeding. Although endoscopic techniques can achieve hemostasis in up to 95% of instances, not all sources of bleeding seen at endoscopy can be managed endoscopically. Massive and diffuse bleeding from locally advanced gastric adenocarcinoma is not usually self-limit-ing and is often refractory to endoscopic treatment. If surgery or endovascular tumor embolization are not possible after failure of endoscopic hemostasis, the situation may become life-threaten-ing. We present a new option for the treatment of patients in this rare but potentially fatal situation, which involves radiofrequency ablation using a needle electrode placed percutaneously un-der ultrasound guidance.

A 46-year-old woman presented with worsening, morphine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarian cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experienced several complications. The pelvic region had radiotherapy up to 70,4 Gy.Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 x 4 cm in size. Computed tomography revealed numerous microfractures and pseudo-arthritic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation.After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermo-ablated by using radiofrequency percutaneously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumor progress or dislocated bone cement. The patient now agreed to further chemotherapy.Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examining quality of life, especially in patients without the options of surgical and radiotherapy.