An apparatus for delivering energy to a target site within bone includes a hollow needle extending from a handle that terminates in a tissue piercing distal tip. A drill within a lumen of the needle is extendable beyond the distal tip, and includes a cutting element and an electrically conductive region. An RF generator may be coupled to the drill for delivering energy to the electrically conductive region, and a driver or actuator may be coupled to the drill for rotating and/or advancing the drill axially. During use, the needle is inserted through a patient's skin to a hard tissue structure, e.g., a bone, including a target site therein, e.g., a tumor. The drill is advanced from the needle, a hole is drilled into the bone until the drill reaches the tumor, and electrical energy is delivered via the electrically conductive region to destroy the tumor.