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Cazzato RL, Palussière J, Buy X, Denaro V, Santini D, Tonini G, Grasso RF, Zobel BB, Poretti D, Pedicini V, Balzarini L, Lanza E. Percutaneous Long Bone Cementoplasty for Palliation of Malignant Lesions of the Limbs: A Systematic Review. Cardiovasc Intervent Radiol 2015; 38:1563-72. [DOI: 10.1007/s00270-015-1082-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
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Cazzato RL, Buy X, Eker O, Fabre T, Palussiere J. Percutaneous long bone cementoplasty of the limbs: experience with fifty-one non-surgical patients. Eur Radiol 2014; 24:3059-68. [DOI: 10.1007/s00330-014-3357-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/03/2014] [Accepted: 07/17/2014] [Indexed: 11/24/2022]
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Abstract
Bone and soft tissue tumor ablation has reached widespread acceptance in the locoregional treatment of various benign and malignant musculoskeletal (MSK) lesions. Many principles of ablation learned elsewhere in the body are easily adapted to the MSK system, particularly the various technical aspects of probe/antenna design, tumoricidal effects, selection of image guidance, and methods to reduce complications. Despite the common use of thermal and chemical ablation procedures in bone and soft tissues, there are few large clinical series that show longitudinal benefit and cost-effectiveness compared with conventional methods, namely, surgery, external beam radiation, and chemotherapy. Percutaneous radiofrequency ablation of osteoid osteomas has been evaluated the most and is considered a first-line treatment choice for many lesions. Palliation of painful metastatic bone disease with thermal ablation is considered safe and has been shown to reduce pain and analgesic use while improving quality of life for cancer patients. Procedure-related complications are rare and are typically easily managed. Similar to all interventional procedures, bone and soft tissue lesions require an integrated approach to disease management to determine the optimum type of and timing for ablation techniques within the context of the patient care plan.
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Affiliation(s)
- Ryan C B Foster
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Joseph M Stavas
- Department of Radiology, the University of North Carolina, Chapel Hill, North Carolina
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Kurup AN, Callstrom MR. Ablation of musculoskeletal metastases: pain palliation, fracture risk reduction, and oligometastatic disease. Tech Vasc Interv Radiol 2014; 16:253-61. [PMID: 24238380 DOI: 10.1053/j.tvir.2013.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thermal ablation is an effective, minimally invasive alternative to conventional therapies in the palliation of painful musculoskeletal metastases and an emerging approach to obtain local tumor control in the setting of limited metastatic disease. Various thermal ablation technologies have been applied to bone and soft tissue tumors and may be used in combination with percutaneous cement instillation for skeletal lesions with or at risk for pathologic fracture. This article reviews current practices of percutaneous ablation of musculoskeletal metastases with an emphasis on radiofrequency ablation and cryoablation of painful skeletal metastases.
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Kastler A, Alnassan H, Aubry S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. J Vasc Interv Radiol 2014; 25:1470-5. [PMID: 25000826 DOI: 10.1016/j.jvir.2014.06.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/06/2014] [Accepted: 06/07/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To assess feasibility, safety, and efficacy of microwave ablation of spinal metastatic bone tumors. MATERIALS AND METHODS Retrospective study of 17 patients with 20 spinal metastatic tumors treated with microwave ablation under computed tomographic guidance between March 2011 and August 2013 was performed. Ablations were performed under local anesthesia and nitrous oxide ventilation. Lesions were lumbar (n = 10), sacral (n = 7), and thoracic (n = 3) in location. Primary neoplastic sites were lung (n = 9), prostate (n = 4), kidney (n = 6), and uterus (n = 1). Adjunct cementoplasty was performed in nine cases, and a temperature-monitoring device was used in four cases. Procedure effectiveness was evaluated by visual analog scale (VAS) during a 6-month follow-up. Patient medical records were reviewed, and demographic and clinical data, tumor characteristics, and information on pain were assessed. RESULTS Mean ablation time was 4.4 minutes ± 2.7 (range, 1-8 min), with an average of 3.8 cycles per ablation at 60 W (range, 30-70 W). The preprocedure mean VAS score was 7.4 ± 1.2 (range, 6-9). Pain relief was achieved in all but one patient. Follow-up VAS scores were as follows: day 0, 1.3 ± 1.8 (P < .001); day 7, 1.6 ± 1.7 (P < .001); month 1, 1.9 ± 1.6 (P < .001); month 3, 2.2 ± 1.5 (P < .001); and month 6, 2.3 ± 1.4 (P < .01). No complications were noted. CONCLUSIONS Microwave ablation appears to be feasible, safe, and an effective treatment of painful refractory spinal metastases and may be considered as a potential alternative percutaneous technique in the management of spinal metastases.
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Affiliation(s)
- Adrian Kastler
- Neuroradiology and MRI Unit, Grenoble University Hospital, Grenoble, France; I4S Laboratory, EA 4268, IFR 133, Franche Comté University, Besançon.
| | - Hussein Alnassan
- I4S Laboratory, EA 4268, IFR 133, Franche Comté University, Besançon
| | - Sébastien Aubry
- I4S Laboratory, EA 4268, IFR 133, Franche Comté University, Besançon; Radiology and Interventional Pain Unit, Besançon University Hospital, Besançon, France
| | - Bruno Kastler
- I4S Laboratory, EA 4268, IFR 133, Franche Comté University, Besançon; Radiology and Interventional Pain Unit, Besançon University Hospital, Besançon, France
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Feasibility of Percutaneous Cementoplasty Combined with Interventional Internal Fixation for Impending Pathologic Fracture of the Proximal Femur. J Vasc Interv Radiol 2014; 25:1112-7. [DOI: 10.1016/j.jvir.2014.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 01/30/2023] Open
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Prologo JD, Patel I, Buethe J, Bohnert N. Ablation Zones and Weight-Bearing Bones: Points of Caution for the Palliative Interventionalist. J Vasc Interv Radiol 2014; 25:769-775.e2. [DOI: 10.1016/j.jvir.2014.01.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/16/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022] Open
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58
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Cementoplasty for managing painful bone metastases outside the spine. Eur Radiol 2013; 24:731-7. [DOI: 10.1007/s00330-013-3071-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/08/2013] [Accepted: 10/28/2013] [Indexed: 01/12/2023]
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59
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Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. J Bone Joint Surg Am 2013; 95:1887-95. [PMID: 24288805 DOI: 10.2106/00004623-201310160-00011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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60
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Épidémiologie, prise en charge et coût des métastases osseuses des cancers bronchopulmonaires (hors métastases rachidiennes). Rev Mal Respir 2013; 30:309-15. [DOI: 10.1016/j.rmr.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/14/2012] [Indexed: 12/25/2022]
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61
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Maurel B, Le Corroller T, Bierry G, Buy X, Host P, Gangi A. Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement. Skeletal Radiol 2013; 42:43-8. [PMID: 22526875 DOI: 10.1007/s00256-012-1392-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/06/2011] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. MATERIALS AND METHODS Five patients (three men, two women; mean age 35 years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. RESULTS The average amount of bone cement injected was 2.1 ml (range, 0.6-3.5 ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4 weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. CONCLUSIONS Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.
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Affiliation(s)
- Boris Maurel
- Service de Radiologie Interventionnelle non Vasculaire, Nouvel Hôpital Civil, 1 Place de L'Hôpital, BP 426, 67 091, Strasbourg Cedex, France.
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Iannessi A, Amoretti N, Marcy PY, Sedat J. Percutaneous cementoplasty for the treatment of extraspinal painful bone lesion, a prospective study. Diagn Interv Imaging 2012; 93:859-70. [DOI: 10.1016/j.diii.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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63
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Driven Around the Bend: Novel Use of a Curved Steerable Needle. Cardiovasc Intervent Radiol 2012; 36:531-5. [DOI: 10.1007/s00270-012-0482-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
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64
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Deschamps F, Farouil G, Hakime A, Barah A, Guiu B, Teriitehau C, Auperin A, deBaere T. Cementoplasty of Metastases of the Proximal Femur: Is It a Safe Palliative Option? J Vasc Interv Radiol 2012; 23:1311-6. [DOI: 10.1016/j.jvir.2012.06.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/01/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022] Open
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Abstract
BACKGROUND Metastatic bone disease is a common cause of pain in cancer patients. A multidisciplinary approach to treatment is often necessary because simplified analgesic regimens may fail in the face of complex pain generators, especially those involved in the genesis of neuropathic pain. From the origins of formalized guidelines by the World Health Organization (WHO) to recent developments in implantable therapies, great strides have been made to meet the needs of these patients. METHODS The authors review the existing literature on the pathophysiology and treatment options for pain generated by metastatic bone disease and summarize classic and new approaches. RESULTS Relatively recent animal models of malignant bone disease have allowed a better understanding of the intimate mechanisms involved in the genesis of pain, resulting in a mechanistic approach to its treatment. Analgesic strategies can be developed with specific targets in mind to complement the classic, opioid-centered WHO analgesic ladder obtaining improved outcomes and quality of life. Unfortunately, high-quality evidence is difficult to produce in pain medicine, and these concepts are evolving slowly. CONCLUSIONS Treatment options are expanding for the challenging clinical problem of painful metastatic bone disease. Efforts are concentrated on developing alternative nonopioid approaches that appear to increase the success rate and improve patients' quality of life.
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Affiliation(s)
- S Buga
- Psychosocial and Palliative Care Program (BS) and the Anesthesiology Program (JES) at the H. Lee Moffi tt Cancer Center and Research Institute, Tampa, Florida, USA
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66
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Abdel-Aal AK, Underwood ES, Saddekni S. Use of cryoablation and osteoplasty reinforced with Kirschner wires in the treatment of femoral metastasis. Cardiovasc Intervent Radiol 2012; 35:1211-5. [PMID: 22565529 DOI: 10.1007/s00270-012-0401-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We report the case of a 43-year-old man with metastatic breast carcinoma to the proximal right femur resulting in severe painful pathological fracture. The patient experienced severe pain despite large doses of analgesia, resulting in impaired functionality and quality of life. The patient had significant comorbidities, making him a high surgical risk. MATERIALS AND METHODS The patient was treated with cryoablation and osteoplasty, followed by a novel technique consisting of osteoplasty reinforced with bone marrow Kirschner wires (K-wires) which will be described in details in this report. RESULTS The patient reported significant pain relief after the procedure, and gained right lower extremity functionality, as compared to total immobility before the procedure. CONCLUSION Our technique offers an alternative feasible treatment for patients at high surgical risk with pathological fractures in weight-bearing bones, in which osteoplasty alone has a high risk of cement leakage, inadequate fracture reduction, and early refracture. To our knowledge, our technique has not been previously described.
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67
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Rosenthal D, Callstrom MR. Critical Review and State of the Art in Interventional Oncology: Benign and Metastatic Disease Involving Bone. Radiology 2012; 262:765-80. [DOI: 10.1148/radiol.11101384] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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68
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Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 2011; 35:1428-32. [PMID: 22203060 DOI: 10.1007/s00270-011-0330-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. METHODS We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score ≥8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. RESULTS The mean Mirels' score was 9.8 ± 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 ± 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 ± 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. CONCLUSIONS POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.
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69
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Painful pathologic fracture of the humerus: percutaneous osteoplasty with bone marrow nails under hybrid computed tomography and fluoroscopic guidance. J Vasc Interv Radiol 2011; 22:1031-4. [PMID: 21708321 DOI: 10.1016/j.jvir.2011.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/06/2011] [Accepted: 02/11/2011] [Indexed: 02/02/2023] Open
Abstract
A case of a 75-year-old patient with a painful pathologic humeral shaft fracture, with unacceptably high surgical risk and unsatisfactory analgesia is reported. In this case, impaired arm function and persistent pain with conservative management resulted in a poor quality of life. Palliation with image-guided percutaneous osteoplasty was considered. Because of potential cement leakage, inadequate fracture reduction, the site of the fracture, and the mobility of the joints in that area, image-guided percutaneous delivery of metallic bone marrow nails implanted together with polymethyl methacrylate (PMMA) osteoplasty was performed. This procedure achieved humeral shaft stabilization, bone fragment alignment, fracture reduction, and pain relief.
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70
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Percutaneous cementoplasty for painful osteolytic humeral metastases: initial experience with an innovative technique. Skeletal Radiol 2011; 40:1345-8. [PMID: 21491154 DOI: 10.1007/s00256-011-1170-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 02/02/2023]
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71
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Castañeda Rodriguez WR, Callstrom MR. Effective Pain Palliation and Prevention of Fracture for Axial-Loading Skeletal Metastases Using Combined Cryoablation and Cementoplasty. Tech Vasc Interv Radiol 2011; 14:160-9. [DOI: 10.1053/j.tvir.2011.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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72
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Abstract
Bone tumors may present as incidental findings, with pain or loss of function, or as fractures. There is a broad range of indications for transarterial embolization (TAE) in primary or metastatic bone tumors: to reduce operative hemorrhagic risks, to simplify or allow more definitive surgery, or in the context of pain palliation, fever, bleeding, or hypercalcemic and other rheological factors. Embolization may also increase tumor sensitivity to chemotherapy or radiation therapy. The procedure itself is often complex with significant risk to adjacent structures and is usually part of a wider treatment strategy. There are many options of embolic agent, techniques, and end points but all aim to devascularize the tumor. Catheter angiography at the time of TAE is used to determine the correct embolic agent and technique with care taken to isolate at risk structures. Many factors determine the best choice of embolic material, probably the most important of which is operator experience. In life-threatening situations or in preoperative embolizations of metastatic tumors, many operators opt for a combination of particulate emboli and stainless steel or platinum coils. Agents discussed include polyvinyl alcohol particles, trisacryl microspheres, gelatin sponge, liquid embolic agents, and embolization coils. Tumor types treated include vascular metastatic lesions, commonly renal cell or thyroid, particularly in locations prone to fracture; giant cell tumors; aneurysmal bone cysts; vertebral hemangiomas, osteosarcomas; arteriovenous malformations; and osteoblastomas. TAE should be considered in the treatment algorithm of primary or secondary bone tumors. Specific benefit is present where there is a high risk of bleeding at surgery, where there is spinal involvement and neural encroachment, where active bleeding is present or in awkward surgical locations where prolonged surgery is anticipated.
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Affiliation(s)
- Richard J T Owen
- Assistant Professor of Radiology, University of Alberta, Edmonton, Alberta, Canada
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73
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Anselmetti GC. Osteoplasty: Percutaneous Bone Cement Injection beyond the Spine. Semin Intervent Radiol 2011; 27:199-208. [PMID: 21629409 DOI: 10.1055/s-0030-1253518] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Percutaneous osteoplasty, the injection of bone cement into a painful bone lesion refractory to conventional therapy (radiotherapy, chemotherapy, and narcotic analgesia), is performed to allow for immediate bone structure consolidation, reduce the risk of a pathological fracture, achieve pain regression, and improve mobility. In this article, the technique of this procedure and a review of the current literature including the author's personal large series will be described.
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Affiliation(s)
- Giovanni Carlo Anselmetti
- Responsabile Radiologia Interventistica, Istituto per la Ricerca e Cura del Cancro, Candiolo, Torino, Italy
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74
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Botton E, Edeline J, Rolland Y, Vauléon E, Le Roux C, Mesbah H, Porée P, Audrain O, Raoul JL. Cementoplasty for painful bone metastases: a series of 42 cases. Med Oncol 2011; 29:1378-83. [DOI: 10.1007/s12032-011-9939-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
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75
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76
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Kurup AN, Callstrom MR. Ablation of Skeletal Metastases: Current Status. J Vasc Interv Radiol 2010; 21:S242-50. [DOI: 10.1016/j.jvir.2010.05.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 05/01/2010] [Accepted: 05/04/2010] [Indexed: 12/11/2022] Open
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Percutaneus osteoplasty in the treatment of extraspinal painful multiple myeloma lesions. Support Care Cancer 2010; 19:957-62. [DOI: 10.1007/s00520-010-0910-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
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78
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Basile A, Tsetis D, Cavalli M, Fiumara P, Di Raimondo F, Coppolino F, Coppolino C, Mundo E, Desiderio C, Granata A, Patti MT. Sacroplasty for local or massive localization of multiple myeloma. Cardiovasc Intervent Radiol 2009; 33:1270-7. [PMID: 19967372 DOI: 10.1007/s00270-009-9761-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 11/06/2009] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to assess the efficacy of cementoplasty in the treatment of sacral multiple myelomas. We retrospectively reviewed the records of eight patients (four women and four men; age range 47-68 years; mean age 57.8) who underwent cementoplasty for painful osteolytic localization of multiple myeloma between April 2007 and May 2009. The patients had difficulty walking because of increasing pain. Six patients had persistent pain despite other cementoplasties for vertebral and femoral localization, whereas two patients referred at the time of diagnosis had only sacral lesions. The clinical indication for treatment was (1) a pain intensity score ≥5 on visual analogue scale (VAS) and (2) pain totally or partially refractory to analgesic treatment in patients with a life expectancy >3 months. Technical planning was based on computed tomography and/or magnetic resonance imaging. Six patients had previously undergone radiotherapy or chemotherapy and were receiving varying doses of analgesics, whereas sacroplasty represented the first treatment for two patients. Five patients had monolateral local involvement, and the other patients had massive involvement of the sacrum; Technical success was achieved in all cases. We had only one small and asymptomatic foraminal leak. All patients experienced improvement in symptoms after the procedure, as demonstrated by improved VAS scores and performance status (PS) and decreased analgesic dose constant during follow-up. In our experience, percutaneous stabilization can be used effectively and safely in patients with focal or extensive involvement of the sacrum by multiple myeloma.
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Affiliation(s)
- Antonio Basile
- Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, via Citelli 6, 95124 Catania, Italy.
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