Interventional Radiology in the Treatment of Musculoskeletal Tumours

Background/Objectives: Primary benign and malignant musculoskeletal tumours are generally treated with surgical excision. Metastatic musculoskeletal disease may require both systemic and local treatment. This review focuses on the use of radiofrequency ablation (RFA), cryoablation, cementoplasty, and high-intensity focused ultrasound (HIFU) in primary musculoskeletal tumours and bone and soft-tissue metastases. Methods: We reviewed English-language studies addressing the indications, clinical outcomes, patient selection, and complications of these techniques in patients with primary musculoskeletal tumours or bone and soft-tissue metastases. Results: RFA is the preferred minimally invasive treatment for osteoid osteoma and may be considered for selected small intraosseous tumours. In symptomatic bone metastases, RFA may provide pain relief and can be combined with cementoplasty when structural support is needed. Cryoablation is used selectively for benign, locally aggressive, recurrent, and metastatic tumours, with the advantage of visualizing the ablation zone. Cementoplasty is mainly used to relieve mechanical pain and reinforce weakened bone. HIFU has been studied mainly for pain palliation in bone metastases, while evidence in primary malignant tumours remains limited. Conclusions: Image-guided interventions can complement surgery and radiotherapy in selected patients. Treatment choice depends on tumour type, location, treatment intent, skeletal stability, and proximity to critical structures.