What to do to beat Langerhans cell histiocytosis of bone? A narrative review and case series of radiofrequency ablation.

Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder in which bone is the commonly affected organ system. While treatment for its symptomatic bone lesions varies, modern minimally invasive techniques show significant advantages over traditional approaches. Conventional therapies present notable limitations. Curettage, while frequently used, is associated with local recurrence. The efficacy of intralesional corticosteroid injections remains uncertain, especially for lesions in the extremities or pelvis. Although effective, low-dose radiation therapy carries long-term risks and is reserved for specific cases. Systemic chemotherapy, the standard for multifocal disease, is associated with toxicity and high relapse rates. Radiofrequency ablation (RFA) has emerged as a superior alternative that fills this therapeutic gap. RFA is a minimally invasive procedure that uses targeted heat (60-100°C) to destroy tumor cells with curative intent. Validating prior case reports, our recent study of ten patients confirmed that RFA provides complete pain relief with no residual disease or recurrence on follow-up MRI. Importantly, no significant complications were observed in our cohort or have been reported in the literature for LCH patients treated with RFA. In conclusion, RFA offers a safe, rapid, and durable solution for painful LCH lesions. It should be considered a primary curative treatment for symptomatic LCH of the bone, avoiding the risks of more invasive procedures and systemic therapies.