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Objective: To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. Materials and methods: From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Results: Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 ( p < 0.001) and 29.6 ± 16.1 mg ( p = 0.003); 7 days, 1.9 ± 1.7 ( p < 0.001) and 16.1 ± 12.0 mg ( p < 0.001); 1 month, 1.5 ± 0.9 ( p < 0.001) and 10.8 ± 10.9 ( p < 0.001); 3 months, 0.9 ± 0.7 ( p < 0.001) and 8.4 ± 9.2 mg ( p < 0.001); and 6 months, 1.2 ± 0.8 ( p < 0.001) and 9.2 ± 12.3 mg ( p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). Conclusion: MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. [ABSTRACT FROM AUTHOR]