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Yildizhan S, Boyaci MG, Rakip U, Aslan A, Canbek I. Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis. BMC Musculoskelet Disord 2021; 22:912. [PMID: 34715849 PMCID: PMC8556885 DOI: 10.1186/s12891-021-04799-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up. Methods Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure. Results The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment. Conclusion Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.
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Affiliation(s)
- Serhat Yildizhan
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey.
| | - Mehmet Gazi Boyaci
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Usame Rakip
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Adem Aslan
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Ihsan Canbek
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
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Optimized CT Attenuation and SUV Prediction Thresholds for Differentiating Enostoses From Untreated and Treated Metastases on Attenuation-Corrected 18F-FDG PET/CT. Clin Nucl Med 2019; 45:32-37. [DOI: 10.1097/rlu.0000000000002808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baliyan A, Punia RS, Kundu R, Dhingra H, Aggarwal P, Garg SK. Histopathological Spectrum of Bone Changes in Skeletal Metastasis. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_142_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Metastatic carcinoma is the most common secondary malignant tumor affecting the bone. Bone is the third most common site for metastasis after lung and liver. The present study was planned to analyze the histomorphological patterns of bone changes in metastatic tumors and their correlation with the radiological findings. Materials and Methods: The current prospective study was conducted over a span of 2 years, encompassing 150 patients with clinically and radiologically suspected metastatic bone disease. Bone biopsy samples were studied for the pattern of bone changes. Results: Of 150 total cases, 30 cases had metastatic bone tumors. The age of the patients ranged from 37 to 84 years (mean: 57.57 ± 11.9 years). Male-to-female ratio was 2:1. All patients with metastasis presented with a complaint of pain followed by tenderness (20, 66.7%). The lesions were commonly located in the vertebral column (14, 46.7%), followed by femur (6, 20%). The primary site was known in 21 (70%) cases. The tumor histotypes were adenocarcinoma (23, 76.7%), squamous cell carcinoma (5, 16.7%), pleomorphic sarcoma (1, 3.3%), and malignant melanoma (1, 3.3%). Histomorphological patterns of bone changes were osteolytic (16, 53.3%), mixed (8, 26.7%), and osteoblastic (6, 20.0%). Correlation between the radiological findings and histopathological patterns of metastases was found to be statistically significant. Conclusions: Histomorphological assessment of bone changes in metastasis is an important parameter. Besides the histological categorization of metastatic bone disease, it plays a pivotal role in identification of the primary tumor site.
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Affiliation(s)
- Asif Baliyan
- Departments of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Rajpal Singh Punia
- Departments of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Reetu Kundu
- Departments of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Harshi Dhingra
- Departments of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Purnima Aggarwal
- Departments of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Sudhir Kumar Garg
- Departments of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Zhao W, Wang H, Hu JH, Peng ZH, Chen JZ, Huang JQ, Jiang YN, Luo G, Yi GF, Shen J, Gao BL. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Jpn J Clin Oncol 2018; 48:753-759. [PMID: 29931084 DOI: 10.1093/jjco/hyy090] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate the pain relief effect and safety of percutaneous radiofrequency ablation (RFA) with a multitined electrode combined with cement injection in patients with painful metastatic bone tumors. Materials and methods Sixteen patients with 34 osteolytic metastatic lesions were treated with RFA including 4 males and 12 females (age range 54-84). Thirteen patients with spinal metastases received additional cement injection. Medical imaging, a visual analog scale (VAS) and the EORTC QLQ-C30 were performed to evaluate the metastatic lesion, pain and quality of life, respectively, before and after RFA and at follow-ups. Results The RFA and/or vertebroplasty with cement injection were successful in all patients (100%). Except for one patient who had cement leakage, no intraprocedural complications occurred. After RFA, severe refractory pain was greatly relieved in all patients, with pretreatment VAS score of 8.1 ± 1.4 significantly reduced to 5.5 ± 1.1 at 24 h, 2.8 ± 0.6 at 1 week and 1.4 ± 0.8 at 6 months (P < 0.01). The EORTC QLQ-C30 scale at 1 month demonstrated significant improvement (P < 0.05) in the physical (P = 0.03) and emotion function (P = 0.003), global health status (P = 0.002), pain (P = 0.001) and insomnia (P = 0.002). The analgesics were reduced after the procedure and stopped 2 months later in all patients, with greatly improved quality of life and no apparent pain. Followed up for 6-12 months, all patients remained alive with no recurrence of pain. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Conclusion RFA with or without bone cement is safe and effective in the palliative treatment of pain caused by metastatic bone tumors.
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Affiliation(s)
- Wei Zhao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Hui Wang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Ji-Hong Hu
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Zhao-Hong Peng
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jin-Zhou Chen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jian-Qiang Huang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Yong-Neng Jiang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Gang Luo
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Gen-Fa Yi
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jin Shen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Bu-Lang Gao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
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Accuracy of CT Attenuation Measurement for Differentiating Treated Osteoblastic Metastases From Enostoses. AJR Am J Roentgenol 2018; 210:615-620. [PMID: 29323547 DOI: 10.2214/ajr.17.18638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of our study was to assess whether the maximum and mean CT attenuations are accurate for differentiating between enostoses and treated sclerotic metastases. MATERIALS AND METHODS We retrospectively reviewed CT studies of 165 patients (167 lesions) that included 49 patients with 49 benign lesions, 69 patients with 71 sclerotic treated lesions, and 47 patients with 47 untreated lesions, and calculated the mean and maximum CT attenuations of each lesion. ROC curves were used to identify thresholds for differentiating enostoses from treated sclerotic metastases and from untreated sclerotic metastases. RESULTS The maximum CT attenuation of enostoses (1212.0 HU) was higher from that of untreated (754.7 HU) (p = 9.7 × 10-16) and that of treated (891.7 HU) (p = 9.9 × 10-10) sclerotic metastases. The maximum CT attenuation of treated sclerotic metastases (891.7 HU) was higher than that of untreated sclerotic metastases (754.7 HU) (p = 0.003). Enostoses had higher mean CT attenuation (1123.0 HU) than untreated (602.0 HU) (p < 2.2 × 10-16) and treated (731.7 HU) (p = 9.6 × 10-15) sclerotic metastases. A threshold mean CT attenuation of 885 HU had an accuracy of 91.7% and 81.7% to differentiate enostoses from untreated and treated metastases, respectively, whereas a threshold maximum CT attenuation of 1060.0 HU had an accuracy of 81.3% and 72.5% to differentiate enostoses from untreated and treated metastases. CONCLUSION The mean and maximum CT attenuations can differentiate between enostoses and sclerotic metastases; however, the accuracy of both metrics decreases after treatment.
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Rygiel KA, Drozd M, Bułaś L. Care of cancer patients with liver and bone metastases - the place of pharmaceutical care in a balanced plan, focused on the patient's needs and goals. Arch Med Sci 2017; 13:1483-1492. [PMID: 29181081 PMCID: PMC5701682 DOI: 10.5114/aoms.2016.60509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/27/2015] [Indexed: 12/23/2022] Open
Abstract
Metastatic cancer, especially in the growing population of geriatric patients, presents a big challenge to these patients, as well as to treatment teams and the entire health care system. This article describes some common medical problems faced by patients with metastases to liver and bone, and presents a diagnostic approach, and therapeutic management of various symptoms, relevant to advanced stages of the malignant disease. The article highlights the importance of patient education on various aspects of metastatic cancer, and underscores the unique position of pharmacists practicing pharmaceutical care, which is particularly beneficial in this group of patients with advanced malignancy. Also, this paper emphasizes that achieving a proper balance between managing the malignant disease and maintaining the patients' quality of life, especially in the elderly population, should involve coordinated efforts of the oncology treatment team, primary care physicians, pharmacists, therapists and nurses, as well as patients, their families and caregivers.
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Affiliation(s)
- Katarzyna A. Rygiel
- Department of Family Practice, Medical University of Silesia, Zabrze, Poland
| | - Mariola Drozd
- Chair and Department of Applied Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Lucyna Bułaś
- Department of Pharmaceutica, Medical University of Silesia, Katowice, Poland
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Peller PJ. Role of positron emission tomography/computed tomography in bone malignancies. Radiol Clin North Am 2013; 51:845-64. [PMID: 24010909 DOI: 10.1016/j.rcl.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article presents an overview of positron emission tomography combined with computed tomography (PET/CT) imaging of bone tumors for the practicing radiologist. The clinical roles and utility of (18)F-labeled fluorodeoxyglucose PET/CT in patients with primary bone tumors, osseous metastases, and multiple myeloma are reviewed. The clinical and research data supporting the utility of PET/CT in the evaluation of skeletal malignancies continues to grow.
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Affiliation(s)
- Patrick J Peller
- Nuclear Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Radiology, College of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Yan W, Xiao J, Liu T, Huang W, Yang X, Wu Z, Huang Q, Qian M. The effects of Hsp90 expression alteration on spinal metastases of breast carcinoma. Tumour Biol 2013; 34:1391-7. [DOI: 10.1007/s13277-012-0584-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/05/2012] [Indexed: 01/06/2023] Open
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Bhamra JS, Malik AA, Aresti NA, Khan WS, Pollock R. The perioperative management of skeletal metastases. J Perioper Pract 2012; 22:24-9. [PMID: 22324118 DOI: 10.1177/175045891202200104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bone metastasis is a common problem affecting a significant proportion of patients with metastatic cancer. Bone metastasis can present in a number of ways and the patients may need surgical stabilisation of their lesions. There are many important considerations in the care of these patients that need to be borne in mind including their increased anesthetic risks and potential risk of complications. There are continuous developments in the prevention, diagnosis and treatment with advances in imaging, orthopaedic technique and medication, particularly radiopharmaceuticals and cytotoxic, endocrine treatments with newer treatments based around the tumour cell-osteoclast interaction. Having a better understanding of these considerations and developments is important in allowing the optimisation of the care of the patient with bone metastasis.
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Garzón-Alvarado DA. A mathematical model for describing the metastasis of cancer in bone tissue. Comput Methods Biomech Biomed Engin 2011; 15:333-46. [PMID: 21264782 DOI: 10.1080/10255842.2010.535522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Metastasis is the rapid proliferation of cancer cells (secondary tumour) at a specific place, generally leading to death. This occurs at anatomical parts providing the necessary environment for vascularity, oxygen and food to hide their actions and trigger the rapid growth of cancer. Prostate and breast cancers, for example, use bone marrow for their proliferation. Bone-supporting cancer cells thus adapt to the environment, mimicking the behaviour of genetic and molecular bone cells. Evidence of this has been given in Cecchini et al. (2005, EAU Update Ser. 3:214-226), providing arguments such as how cancer cell growth is so active during bone reabsorption. This paper simulates metastasis activation in bone marrow. A mathematical model has been developed involving the activation of molecules from bone tissue cells, which are necessary for cancer to proliferate. Here, we simulate two forms of secondary tumour growth depending on the type of metastasis: osteosclerosis and osteolysis.
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Affiliation(s)
- Diego Alexander Garzón-Alvarado
- Department of Mechanical and Mechatronics Engineering, National University of Colombia, Cra 30 45-03 Ed. 407 of 103A, Bogotá, Colombia.
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