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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Koirala N, Joshi J, Duffy SF, McLennan G. Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions. J Clin Med 2022; 11:jcm11195572. [PMID: 36233434 PMCID: PMC9571370 DOI: 10.3390/jcm11195572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Percutaneous-reinforced osteoplasty is currently being investigated as a possible therapeutic procedure for fracture stabilization in high-risk patients, primarily in patients with bone metastases or osteoporosis. For these patients, a percutaneous approach, if structurally sound, can provide a viable method for treating bone fractures without the physiologic stress of anesthesia and open surgery. However, the low strength of fixation is a common limitation that requires further refinement in scaffold design and selection of materials, and may potentially benefit from tissue-engineering-based regenerative approaches. Scaffolds that have tissue regenerative properties and low inflammatory response promote rapid healing at the fracture site and are ideal for percutaneous applications. On the other hand, preclinical mechanical tests of fracture-repaired specimens provide key information on restoration strength and long-term stability and enable further design optimization. This review presents an overview of percutaneous-reinforced osteoplasty, emerging treatment strategies for bone repair, and basic concepts of in vitro mechanical characterization.
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Affiliation(s)
- Nischal Koirala
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jyotsna Joshi
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Stephen F. Duffy
- Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Gordon McLennan
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
- Correspondence:
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Letty Q, Grange R, Bertholon S, Barral FG, Brosse C, Morisson S, Stacoffe N, Grange S. Percutaneous screw fixation and cementoplasty of metastatic sternal fracture: Descriptions of 2 cases. Radiol Case Rep 2022; 17:2227-2230. [PMID: 35496755 PMCID: PMC9048053 DOI: 10.1016/j.radcr.2022.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Quentin Letty
- Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Rémi Grange
- Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Sylvain Bertholon
- Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Fabrice-Guy Barral
- Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Christelle Brosse
- Department of supportive care in Oncology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Stéphanie Morisson
- Department of supportive care in Oncology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
| | - Nicolas Stacoffe
- Department of Radiology, Lyon University Hospital, Lyon South Hospital center, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - Sylvain Grange
- Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France
- Corresponding author.
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Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:34. [PMID: 35118339 PMCID: PMC8794297 DOI: 10.21037/med-21-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/03/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Traumatic sternal fractures are injuries most commonly resulting from a direct blow to the anterior chest wall or forced deceleration. The purpose of this review is to define the clinical significance of these injuries, outline their initial evaluation and work up, and review current treatment strategies available and their outcomes. BACKGROUND The diagnosis of traumatic sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan. Currently, there are no published guidelines to make recommendations on operative fixation for sternal fractures. This is probably related to the lack of evidence in published literature along with patient heterogeneity. METHODS We conducted a non-systematic review of the English literature published from January 2000 to December 2020, including meta-analyses, systematic reviews, case series and case reports regarding the diagnosis, treatment, and complications of traumatic sternal fractures. We critically analyzed the available evidence to provide an overview of the treatment and clinical outcomes of traumatic sternal fractures. CONCLUSION Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting. Polytrauma patients with sternal fractures should be carefully screened for possible associated injuries. Surgical stabilization of sternal fractures is feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion or non-union.
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Affiliation(s)
| | - Ilitch Diaz-Gutierrez
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
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Assouline J, Tselikas L, Roux C, Yevich S, Delpla A, Najafi A, Al Ahmar M, Bijot JC, de Baère T, Deschamps F. Prophylactic Percutaneous Consolidation of Large Osteolytic Tumors of the Pelvic Ring Using Fixation by Internal Cemented Screws. Radiol Imaging Cancer 2021; 3:e200137. [PMID: 33988476 DOI: 10.1148/rycan.2021200137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the efficacy, durability, and safety of percutaneous fixation by internal cemented screw (FICS) for prophylactic consolidation of impending pathologic fractures of the pelvic ring. Materials and Methods In this single-institute retrospective study, patients with large, minimally symptomatic to asymptomatic osteolytic tumors of the pelvic ring that were treated with percutaneous cone-beam CT-guided FICS procedures were included (January 2014 to May 2019). Follow-up cross-section imaging and clinical reports were reviewed for procedural complications and assessment of the long-term consolidation efficacy on the basis of the development of pathologic fracture or need for additional surgical intervention. All continuous variables were expressed as a mean with standard deviation, and dichotomous variables were expressed as frequencies and percentages. Results Fifty consecutive patients (mean age, 60 years ± 12; 27 men) underwent prophylactic FICS for consolidation of 54 osteolytic tumors (mean size, 51 mm ± 21.5; range, 30-114 mm). Local tumor destruction was performed in association with FICS in 38 patients (76%) using percutaneous thermal and/or radiation therapy. Follow-up exceeded a year in 35 patients (70%), with mean follow-up of 22 months ± 18 (range, 1-67 months). Long-term consolidation efficacy was 98% (49 of 50), with the development of a pathologic fracture in only one patient 20 months after FICS. Procedural complications were limited to two patients with self-resolving hematoma, one patient with inflammatory sciatic pain, and one patient with focal pain at the ischial tuberosity. Conclusion Percutaneous FICS provides a safe and durable minimally invasive treatment for the prevention of pathologic fractures of the pelvic ring. Keywords: Interventional-MSK, Percutaneous, Skeletal-Axial, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Jessica Assouline
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Charles Roux
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Alexandre Delpla
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Arash Najafi
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Marc Al Ahmar
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Jean-Charles Bijot
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baère
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frédéric Deschamps
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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Autrusseau PA, Garnon J, Bertucci G, Dalili D, De Marini P, Auloge P, Koch G, Caudrelier J, Weiss J, Cazzato RL, Gangi A. Complications of percutaneous image-guided screw fixation: An analysis of 94 consecutive patients. Diagn Interv Imaging 2021; 102:347-353. [PMID: 33516740 DOI: 10.1016/j.diii.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively assess the safety profile of percutaneous image-guided screw fixation (PIGSF) for insufficiency, impending or pathological fractures. MATERIALS AND METHODS From July 2012 to April 2020, all consecutive patients who underwent PIGSF were retrospectively included in the study. Patient characteristics, fracture type, procedural data and complications were analyzed. Complications were divided into per-procedural, early (<24hours) and delayed (>24hours) and classified into minor (grade 1-2) and major complications (grade 3-5) according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS A total of 110 fractures (40 insufficiency [36%], 53 pathological [48.5%] and 17 impending [15.5%] fractures) in 94 patients (48 women, 46 men; mean age, 62.7±12.7 [SD] years; age range: 32-88 years) were treated with PIGSF during 95 procedures. Twenty-four-hours follow-up was available for all patients, and>24-hours follow-up was available for 79 (79/110; 71.8%) fractures in 69 (69/94; 73.4%) patients. Per-procedural complications occurred in 3/110 fractures (2.7%, all minor). Early complications were reported in 4/110 fractures (3.6%, 1 major and 3 minor) and delayed ones in 14/79 fractures (17.7%, 5 major and 9 minor). The most frequent major delayed complication was infection (3/79; 3.8%). CONCLUSION The rate of per-procedural and early (within 24hours) complications following PIGSF is extremely low with most complications being minor, with major complications being delayed ones (>24hours).
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Affiliation(s)
- Pierre-A Autrusseau
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Grégory Bertucci
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, OX3 7LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, WC2R 2LS London, United Kingdom
| | - Pierre De Marini
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Roberto L Cazzato
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
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