Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization

Bone Consolidation: A Practical Guide for the Interventional Radiologist

In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones.

Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review

Background

Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours.

Aims

In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted.

Material and methods

A retrospective search using the keyword 'musculoskeletal system', 'neoplasms', 'biopsy', and 'interventional radiology' was performed at our tertiary care oncology orthopaedic referral centre radiology database. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS). Electronic Patient Records, histopathology laboratory records and patient characteristics were collaborated to generate this narrative experience at our centre.

Results

Image-guided interventional procedures have been utilised in a spectrum of primary and secondary MSK tumours. Current applications include diagnosis of bone and soft tissue MSK neoplastic lesions with biopsies, thermal, cryotherapy and Radiofrequency ablations and augmentation procedures.

Conclusion

Musculoskeletal (MSK) image-guided interventions have increasing applications in the diagnosis, management, treatment and monitoring of patients with MSK tumours. The emergence of newer imaging technologies with enhanced skills of interventional radiologists will allow a range of therapeutic MSK interventions in both effective control of primary lesions and palliative care of metastatic lesions.

The New Ice Age of Musculoskeletal Intervention: Role of Percutaneous Cryoablation in Bone and Soft Tissue Tumors

In the rapidly evolving field of interventional oncology, minimally invasive methods, including CT-guided cryoablation, play an increasingly important role in tumor treatment, notably in bone and soft tissue cancers. Cryoablation works using compressed gas-filled probes to freeze tumor cells to temperatures below -20 °C, exploiting the Joule-Thompson effect. This cooling causes cell destruction by forming intracellular ice crystals and disrupting blood flow through endothelial cell damage, leading to local ischemia and devascularization. Coupling this with CT technology enables precise tumor targeting, preserving healthy surrounding tissues and decreasing postoperative complications. This review reports the most important literature on CT-guided cryoablation's application in musculoskeletal oncology, including sarcoma, bone metastases, and bone and soft tissue benign primary tumors, reporting on the success rate, recurrence rate, complications, and technical aspects to maximize success for cryoablation in the musculoskeletal system.

Precision pain management in interventional radiology

Pain is a common manifestation of several benign and malignant conditions. Inadequate response to conservative therapies is often succeeded by incremental use of analgesics and opioids; however, such an approach is often ineffective, not well tolerated by patients, and carries the risk of addiction leading to the opioid crisis. Implementing minimally invasive percutaneous procedures, performed by interventional radiologists has proven to be successful in providing safe, effective, and patient-specific therapies across a wide range of painful conditions. In the present narrative review, we will review the repertoire of minimally invasive imaging guided interventions, which have been successfully used to treat common painful benign and malignant conditions. We briefly describe each technique, common indications, and expected results.

Current Status and Prospects of Clinical Treatment of Osteosarcoma

Osteosarcoma, one of the common malignant tumors in the skeletal system, originates in mesenchymal tissue, and the most susceptible area of occurrence is the metaphysis with its abundant blood supply. Tumors are characterized by highly malignant spindle stromal cells that can produce bone-like tissue. Most of the osteosarcoma are primary, and a few are secondary. Osteosarcoma occurs primarily in children and adolescents undergoing vigorous bone growth and development. Most cases involve rapid tumor development and early blood metastasis. In recent years, research has grown in the areas of molecular biology, imaging medicine, biological materials, applied anatomy, surgical techniques, biomechanics, and comprehensive treatment of tumors. With developments in molecular biology and tissue bioengineering, treatment methods have also made great progress, especially in comprehensive limb salvage treatment, which significantly enhances the quality of life after surgery and improves the 5-year survival rate of patients with malignant tumors. This article provides a review of limb salvage, immunotherapy, gene therapy, and targeted therapy from traditional amputation to neoadjuvant chemotherapy, providing a reference for current clinical treatments for osteosarcoma.