1
|
Letty Q, Grange R, Bertholon S, Thomas T, Beneton A, Morisson S, Boutet C, Grange S. Percutaneous Fixation with Internal Cemented Screws for Iliac Lytic Bone Metastases: Assessment of Pain and Quality of Life on Long Term Follow-up. Cardiovasc Intervent Radiol 2024; 47:980-990. [PMID: 38782766 DOI: 10.1007/s00270-024-03746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To assess effectiveness on pain, quality of life and late adverse events of percutaneous fixation with internal cemented screw (FICS) among patients with iliac lytic bone metastases with or without pathological fractures. MATERIALS AND METHODS This retrospective exploratory study analyzed FICS procedures on iliac osteolytic bone lesions with and without pathological fracture performed from July 2019 to January 2022 in one tertiary level university hospital. The procedure were performed under general anesthesia, and were CT and fluoroscopically guided. Numerical Pain Rate Score (NPRS), mean EuroQol visual analogue scale (EQ VAS), morphine consumption, walking ability, walking perimeter and presence of walking aids and the appearance of complications were evaluated. RESULTS Nineteen procedures among 18 patients were carried out with a mean follow up time of 243.3 ± 243.2 days. The mean of the maximum NPRS decreased from 8.4 ± 1.3 to 2.2 ± 3.1 at 1 month (p < 0.01) and remained between 1.3 and 4.1 during a follow-up consultation period of 3-24 months. The mean EQ VAS rose from 42.0 ± 12.5 to 57.3 ± 13.9 at 1 month (p < 0.01) follow-up and remained between 55.8 and 62.5 thereafter. No patient scores returned to pre-procedure levels during follow-up. Mean morphine use decreased from 111.1 ± 118.1 to 57.8 ± 70.3 mg/d at 1 month (p > 0.05) follow-up. No late adverse events were reported. CONCLUSION Percutaneous FICS is a safe procedure with fast and long-standing effect on pain, mobility and quality of life. It can be used as a complement to the known analgesic therapeutic arsenal for bone metastases.
Collapse
Affiliation(s)
- Quentin Letty
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Rémi Grange
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Sylvain Bertholon
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Thierry Thomas
- Department of Rhumatology, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Aurelie Beneton
- Department of Supportive Care in Oncology, Lucien Neuwirth Cancer Institute, 5 Rue Charles de Gaulle, 42055, Saint-Etienne Cedex 2, France
| | - Stéphanie Morisson
- Department of Supportive Care in Oncology, Lucien Neuwirth Cancer Institute, 5 Rue Charles de Gaulle, 42055, Saint-Etienne Cedex 2, France
| | - Claire Boutet
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Sylvain Grange
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France.
| |
Collapse
|
2
|
Tomasian A, Levy J, Jennings JW. Percutaneous Vertebral Augmentation and Thermal Ablation in Patients with Spinal Metastases. Semin Intervent Radiol 2024; 41:170-175. [PMID: 38993602 PMCID: PMC11236444 DOI: 10.1055/s-0044-1787166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Vertebral augmentation and thermal ablation offer radiologists a robust minimally invasive option for treatment of patients with spinal metastases. Such interventions are commonly combined and have proved safe and effective in the management of selected patients with vertebral metastases with durable treatment effects. Special attention to procedure techniques including choice of vertebral augmentation technique, choice of ablation modality, and thermal protection is essential for improved patient outcomes. This article provides a review of the most recent advances in vertebral augmentation and thermal ablation for the treatment of spinal metastases.
Collapse
Affiliation(s)
- Anderanik Tomasian
- Division of Radiological Sciences, Department of Radiology, University of California, Irvine, California
| | - Jason Levy
- Department of Radiology, Northside Radiology Associates, Atlanta, Georgia
| | - Jack W Jennings
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| |
Collapse
|
3
|
Barral M, Chevallier O, Cornelis FH. Perspectives of Cone-beam Computed Tomography in Interventional Radiology: Techniques for Planning, Guidance, and Monitoring. Tech Vasc Interv Radiol 2023; 26:100912. [PMID: 38071025 DOI: 10.1016/j.tvir.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cone-beam computed tomography (CBCT) has emerged as a prominent imaging modality in interventional radiology that offers real-time visualization and precise guidance in various procedures. This article aims to provide an overview of the techniques used to guide and monitor interventions that use CBCT. It discusses the advantages of CBCT, its current applications, and potential future CBCT-related developments in the field of interventional radiology.
Collapse
Affiliation(s)
- Matthias Barral
- Department of Radiology, Tenon Hospital, Paris, France; Paris Sorbonne Université, France.
| | | | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medicine Medical College, New York, NY
| |
Collapse
|
4
|
Zuo D, Sun M, Mu H, Shen J, Wang C, Sun W, Cai Z. O-arm-guided percutaneous microwave ablation and cementoplasty for the treatment of pelvic acetabulum bone metastasis. Front Surg 2022; 9:929044. [PMID: 36171820 PMCID: PMC9510637 DOI: 10.3389/fsurg.2022.929044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to evaluate the indications, safety, and efficacy of microwave ablation combined with cementoplasty under O-arm navigation for the treatment of painful pelvic bone metastasis. Methods We retrospectively collected data from 25 patients with acetabulum bone metastasis who underwent microwave ablation combined with cementoplasty. All patients underwent percutaneous microwave ablation combined with cementoplasty under O-arm navigation. The postoperative follow-up included evaluations of pain, quality of life, function, the incidence of bone cement leakage, and the presence of perioperative complications. Pain and quality of life were evaluated using the visual analog scale (VAS) and the QLQ-BM22 quality of life questionnaire for patients with bone metastases, respectively. The functional scores were calculated using the MSTS93 scoring system of the Bone and Soft Tissue Oncology Society. Results There were 10 males and 15 females with an average age of 52.5 ± 6.5 years, all 25 patients received percutaneous procedures, and no technical failure occurred. Major complications, including pulmonary embolism, vascular or nervous injury, hip joint cement leakage, and infection, were not observed in the current study. Pain regression was achieved in 24 of 25 patients. The mean VAS scores significantly decreased to 3.4 ± 1.0, 2.5 ± 1.2, and 1.2 ± 0.6 points at 1 week, 1 month, and 3 months after the procedure, respectively, compared with 7.0 points before the procedure (P < .05). The mean QLQ-BM22 score significantly decreased to 36.2 ± 4.9, 30 ± 5.6, and 25.4 ± 2.3 points at 1 week, 1 month, and 3 months after the procedure, respectively, compared with 55.8 points before the procedure (P < .05). The preoperative Musculoskeletal tumour society (MSTS) functional score of 25 patients was 18.5 ± 5.3 points, and MSTS score was 20.0 ± 3.0, 21.4 ± 4.9, and 22.8 ± 2.3 at 1 week, 1 month, and 3 months after the procedure, respectively (P < .05). The average bone cement injection volume was 8.8 ± 4.6 ml. Conclusion The use of O-arm-guided percutaneous microwave ablation combined with cementoplasty for the treatment of pelvic metastases could quickly and significantly alleviate local pain, prevent pathological fracture, and improve the quality of life of patients with reduced complications.
Collapse
Affiliation(s)
- Dongqing Zuo
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengxiong Sun
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Mu
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Bone Tumor Institute, Shanghai, China
| | - Jiakang Shen
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chongren Wang
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Sun
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Wei Sun
| | - Zhengdong Cai
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
5
|
Tomasian A, Jennings JW. Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases. Semin Intervent Radiol 2022; 39:176-183. [PMID: 35781996 DOI: 10.1055/s-0042-1745787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The musculoskeletal system is commonly involved by metastases, and skeletal-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a result of nerve compression often adversely affect patient's quality of life. There have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections which are progressively incorporated in clinical practice. These interventions are performed, in conjunction with or supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesics, to achieve durable pain palliation, local tumor control, or cure. This article reviews minimally invasive percutaneous image-guided musculoskeletal oncologic interventions for the management of patients with extraspinal musculoskeletal metastases.
Collapse
Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of California Irvine, Orange, California
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri
| |
Collapse
|
6
|
Tomasian A, Jennings JW. Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology. Radiographics 2021; 41:1475-1492. [PMID: 34469219 DOI: 10.1148/rg.2021210007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.
Collapse
Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Assessment of risk factors for occurrence or worsening of acetabular fracture following percutaneous cementoplasty of acetabulum malignancies. Eur J Radiol 2019; 120:108694. [DOI: 10.1016/j.ejrad.2019.108694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/29/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
|
9
|
Garnon J, Meylheuc L, Cazzato RL, Dalili D, Koch G, Auloge P, Bayle B, Gangi A. Percutaneous extra-spinal cementoplasty in patients with cancer: A systematic review of procedural details and clinical outcomes. Diagn Interv Imaging 2019; 100:743-752. [PMID: 31427218 DOI: 10.1016/j.diii.2019.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To perform a systematic review of technical details and clinical outcomes of percutaneous extra-spinal cementoplasty in patients with malignant lesions. MATERIALS AND METHODS PUBMED, MEDLINE, MEDLINE in-process, EMBASE and the Cochrane databases were searched between January 1990 and February 2019 using the keywords «percutaneous cementoplasty», «percutaneous osteoplasty» and «extra-spinal cementoplasty». Inclusion criteria were: retrospective/prospective cohort with more than 4 patients, published in English language, reporting the use of percutaneous injection of cement inside an extra-spinal bone malignant tumour using a dedicated bone trocar, as a stand-alone procedure or in combination with another percutaneous intervention, in order to provide pain palliation and/or bone consolidation. RESULTS Thirty articles involving 652 patients with a total of 761 lesions were reviewed. Mean size of lesion was 45mm (range of mean size among publications: 29-73mm); 489 lesions were located in the pelvis, 262 in the long bones of the limbs and 10 in other locations. Cementoplasty was reported as a stand-alone procedure for 60.1% of lesions, and combined with thermal ablation for 26.2% of lesions, implant devices for 12.3% of lesions, and balloon kyphoplasty for 1.4% of lesions. The mean volume of injected cement was 8.8mL (range of mean volume among publications: 2.7-32.2mL). The preoperative visual analogic scores ranged between 3.2 and 9.5. Postoperative scores at last available follow-up ranged from 0.4 to 5.6. Thirteen papers reported a reduction of the visual analogic scores of 5 points or more. Nerve injury was the most frequent symptomatic leakage (0.6%). CONCLUSION Percutaneous extra-spinal cementopasty is predominantly performed as a stand-alone procedure and for lesions in the bony pelvis. It appears to be an effective tool to manage pain associated with malignant bone tumours. There is however a lack of standardization of the technique among the different publications.
Collapse
Affiliation(s)
- J Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 67096 Strasbourg cedex, France; UMR 7357 CNRS, ICube, INSA Strasbourg, University of Strasbourg, 67091 Strasbourg, France.
| | - L Meylheuc
- UMR 7357 CNRS, ICube, INSA Strasbourg, University of Strasbourg, 67091 Strasbourg, France
| | - R L Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 67096 Strasbourg cedex, France
| | - D Dalili
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 21287 Baltimore, MD, USA
| | - G Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 67096 Strasbourg cedex, France
| | - P Auloge
- Department of Interventional Radiology, Nouvel Hôpital Civil, 67096 Strasbourg cedex, France
| | - B Bayle
- UMR 7357 CNRS, ICube, INSA Strasbourg, University of Strasbourg, 67091 Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 67096 Strasbourg cedex, France; UMR 7357 CNRS, ICube, INSA Strasbourg, University of Strasbourg, 67091 Strasbourg, France
| |
Collapse
|