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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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Ke J, Cheng S, Yao MY, Chu X, Wang M, Zeng XL, Yang T, Zhang C, Zhong H, Zhang Y. Novel Strategy of Curettage and Adjuvant Microwave Therapy for the Treatment of Giant Cell Tumor of Bone in Extremities: A Preliminary Study. Orthop Surg 2021; 13:185-195. [PMID: 33442922 PMCID: PMC7862174 DOI: 10.1111/os.12865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives To evaluate whether curettage with adjuvant microwave therapy was successful in the treatment of giant cell tumor of the bone (GCTB) in extremities, especially for GCTB with pathological fractures and GCTB of the distal radius. Methods This was a retrospective study of 54 cases of GCTB of the extremities treated by curettage with adjuvant microwave therapy between 2007 and 2019. Five patients were lost to follow up and excluded from the study. A total of 33 male and 21 female patients were included in this study. Patients were aged 15–57 years (mean 29.72 ± 10.48 years). Among these patients, there were 10 cases of GCTB with pathological fractures and eight cases of GCTB of the distal radius; one of these cases was combined with a pathological fracture. Comprehensive imaging examinations (X‐rays [including lesion site and chest], CT, MRI, emission computed tomography, and pathology examination) of all patients were reviewed. The clinical staging of these patients were evaluated radiologically using the Campanacci classification system based on the extent of spread of the tumor. All patients underwent curettage with adjuvant microwave therapy. Clinical and imaging evaluations were performed in all cases to check for recurrence or metastasis. Lower limb and upper limber function were assessed using the Musculoskeletal Tumor Society score (MSTS), and wrist function was assessed according to the disabilities of the arm, shoulder and hand (DASH) score. Data on surgical‐related complications were recorded. Results All cases were followed up for 24–126 months (mean 60.69 ± 29.61 months). There were 24 patients with a Campanacci grade of 3 and 30 with a Campanacci grade of 2. The 52 patients were continuously disease‐free. The local recurrence rate was 3.70% (2 patients). One patient had recurrence in the proximal femur, and the other developed in soft tissue of the calf muscle. No recurrence occurred for GCTB of the distal radius. One recurrence occurred in a GCTB with pathological fractures. The intervals were 9 and 28 months, respectively. The cases of recurrence all had a Campanacci grade of 3 (8.33%). The median MSTS among the 54 patients was 27.67 ± 3.81. The mean wrist function DASH score was 8.30 ± 2.53. The mean MSTS was 28.67 ± 1.63 and 26.71 ± 5.49 for patients with GCTB of the distal radius and for those with pathological fractures, respectively. In comparing patients with and without pathological fractures, there was no significant difference in the MSTS functional score. Five patients had complications after the surgery. Conclusion Curettage with adjuvant microwave ablation therapy provided favorable local control and satisfactory functional outcomes in the treatment of GCTB, especially for cases with pathological fractures and those with GCTB of the distal radius.
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Affiliation(s)
- Jin Ke
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Meng-Yu Yao
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Chu
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ming Wang
- Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Xiao-Long Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chi Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hua Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. Semin Musculoskelet Radiol 2020; 24:692-709. [PMID: 33307585 DOI: 10.1055/s-0040-1719103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Dalili D, Isaac A, Cazzato RL, Åström G, Bergh J, Mansour R, Weber MA, Garnon J, Gangi A. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization. Semin Musculoskelet Radiol 2020; 24:710-725. [PMID: 33307586 DOI: 10.1055/s-0040-1719104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Percutaneous image-guided oncologic interventions have rapidly evolved over the last two decades as an independent strategy or used within a first-, second-, or even third-line strategy in the treatment of musculoskeletal (MSK) tumors. Abundant mostly nonrandomized publications have described the safety, efficacy, and reproducibility of implementing percutaneous therapies both with curative and palliative intent. In this article, we continue to share our experience in bone and MSK soft tissue interventions focusing on stabilization and combined ablation and stabilization. We propose a pathway and explore future directions of image-guided interventional oncology related to skeletal disease. We reflect on the advantages and limitations of each technique and offer guidance and pearls to improve outcomes. Representing patterns from our practices, we demonstrate the role of collaborative working within a multidisciplinary team, ideally within a dedicated tumor treatment center, to deliver patient-specific therapy plans that are value based and favored by patients when given the choice.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Roberto Luigi Cazzato
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Julien Garnon
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Afshin Gangi
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom.,Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
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Ke J, Cheng S, Yang T, Zhang C, Wang M, Zhang Y. Feasibility of Controlling Metastatic Osseous Pain Using Three Kinds of Image-Guided Procedures for Thermal Microwave Ablation: A Retrospective Study. Orthop Surg 2020; 13:116-125. [PMID: 33305522 PMCID: PMC7862186 DOI: 10.1111/os.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the feasibility and safety of treating painful osseous metastases using image‐guided percutaneous thermal microwave ablation. Methods This is a retrospective study of patients treated from December 2016 to December 2019 in one institute. A total of 50 patients (35 men, 15 women; mean age 55.24 ± 11.03 years) with 56 osseous metastatic lesions underwent image‐guided percutaneous microwave ablation. There were 7 patients with multiple and 43 patients with single metastases. The numbers of patients with primary cancer were as follows: lung, 13; liver, 17; kidney, 10; prostate, 1; breast, 3; osteosarcoma, 1; and thyroid, 5. Seventeen patients had cancer combined with soft tissue masses. The radiological images for the ablative procedures were obtained by CT, fluoroscopy with ultrasound, and fluoroscopy alone in 16, 11, and 23 patients, respectively. Pain severity was estimated using the visual analogue scale before and after treatment (1 week, 1 month, and 3 months after treatment). Radiological evaluations were performed at baseline and 3 months after the procedure. Results In all patients, pain reduction occurred from the first day after treatment. Pain did not recur during the 3 months of follow up. The mean total ablation time per microwave electrode was 3.99 ± 2.48 min (range, 1–15 min). The mean power of the microwave electrode was 66.40 ± 12.08 W. The average volume of bone (load‐bearing bone, such as vertebra and acetabulum) cement after ablation was 2.82 ± 0.81 mL. There were no significant differences in visual analogue scale pain scores for different imaging techniques or ablation energies. No procedure‐related complications occurred. Conclusion Image‐guided percutaneous thermal microwave ablation of osseous metastases relieves pain and improves mobility. CT remains the first choice for percutaneous ablation. Fluoroscopy combined with ultrasound is effective for cases with soft tissue masses; fluoroscopy is also suitable for combination with vertebroplasty. However, further investigations are required. (A) Microwave ablation probe. (B) Temperature probe in the vertebral body and in the vertebral pedicle (parallel to the posterior margin). (C) Metastatic tumor. The thick white line of the ablation probe tip represents the source of microwave needle emission. The orange region represents the heating range of the microwave.
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Affiliation(s)
- Jin Ke
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chi Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Wang
- Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yu Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Bittman RW, Friedberg EB, Fleishon HB, Prologo JD. Global Approach to the Patient with Pain in Interventional Radiology. Semin Intervent Radiol 2018; 35:342-349. [PMID: 30402017 DOI: 10.1055/s-0038-1673362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ross W Bittman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Eric B Friedberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Radiology, Emory Johns Creek Hospital, Johns Creek, Georgia
| | - J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Mastier C, Gjorgjievska A, Thivolet A, Bouhamama A, Cuinet M, Pilleul F, Tselikas L, de Baère T, Deschamps F. Musculoskeletal Metastases Management: The Interventional Radiologist's Toolbox. Semin Intervent Radiol 2018; 35:281-289. [PMID: 30402011 DOI: 10.1055/s-0038-1673420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The prevalence of patients with painful bone metastases is constantly increasing. This is related to the rising incidence of cancer and increasing life expectancy of patients with metastatic stage. Advances in imaging and development of percutaneous techniques have gradually allowed offering minimally invasive acts on these metastases: cementing, vertebral augmentation, osteosynthesis, percutaneous thermal ablation, neurolysis, embolization. The purpose of this article is to present the main tools available to date for the interventional radiologist so that each participant can understand their functioning, indications, and limits.
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Affiliation(s)
- Charles Mastier
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Ana Gjorgjievska
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Arnaud Thivolet
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Amine Bouhamama
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Marie Cuinet
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Franck Pilleul
- Interventional Radiology Department, CLCC Léon Bérard 28 prom, Lyon, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
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Bousson V, Hamze B, Odri G, Funck-Brentano T, Orcel P, Laredo JD. Percutaneous Vertebral Augmentation Techniques in Osteoporotic and Traumatic Fractures. Semin Intervent Radiol 2018; 35:309-323. [PMID: 30402014 DOI: 10.1055/s-0038-1673639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Percutaneous vertebral augmentation/consolidation techniques are varied. These are vertebroplasty, kyphoplasty, and several methods with percutaneous introduction of an implant (associated or not with cement injection). They are proposed in painful osteoporotic vertebral fractures and traumatic fractures. The objectives are to consolidate the fracture and, if possible, to restore the height of the vertebral body to reduce vertebral and regional kyphosis. Stabilization of the fracture leads to a reduction in pain and thus restores the spinal support function as quickly as possible, which is particularly important in the elderly. The effectiveness of these interventions on fracture pain was challenged once by two randomized trials comparing vertebroplasty to a sham intervention. Since then, many other randomized studies in support of vertebroplasty efficacy have been published. International recommendations reserve vertebroplasty for medical treatment failures on pain, but earlier positioning may be debatable if the objective is to limit kyphotic deformity or even reexpand the vertebral body. Recent data suggest that in osteoporotic fracture, the degree of kyphosis reduction achieved by kyphoplasty and percutaneous implant techniques, compared with vertebroplasty, is not sufficient to justify the additional cost and the use of a somewhat longer and traumatic procedure. In young patients with acute traumatic fractures and a significant kyphotic angle, kyphoplasty and percutaneous implant techniques are preferred to vertebroplasty, as in these cases a deformity reduction has a significant positive impact on the clinical outcome.
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Affiliation(s)
- Valérie Bousson
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Bassam Hamze
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Guillaume Odri
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Thomas Funck-Brentano
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Philippe Orcel
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Jean-Denis Laredo
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
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