Clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty for palliative treatment in pelvic osteolytic metastases

OBJECTIVES

To evaluate the impact of microwave ablation (MWA) on pain relief, quality of life, mobility, and local tumour progression in adult patients with pelvic osteolytic bone metastasis and to test the safety of MWA.

METHODS

This study retrospectively analysed the data from 20 patients with pelvic osteolytic metastases who received MWA combined with percutaneous osteoplasty (POP). The visual analogue scale (VAS), musculoskeletal tumour society system (MSTS), and Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22) were used to evaluate the pain, limb function, and quality of life. The intraoperative and postoperative complications were recorded. The tumour recurrence and survival time were analysed during the follow-up period (range 3-26 months).

RESULTS

All (n = 20) MWA and POP operations were completed successfully. Four patients (20%; 95% CI, 6%-44%) had mild bone cement leakage from surrounding tissues, and there were no obvious symptoms or serious complications. There were significant differences in VAS, MSTS, and QLQ-BM22 scores before and after the operation (P < .001). During the postoperative follow-up period, 9 patients died. The median survival time was 8 months (range 3-26 months; IQR: 4.5-13; 95% CI, 4.2-15.3 months), and the 1-year survival rate was 65% (13/20; 95% CI, 41%-85%). Tumour recurrence occurred in 4 cases (20%; 95% CI, 6%-44%) after the operation, and the median time of recurrence was 12 months (range 8-16 months; IQR: 8.25-12.75; 95% CI, 5.5-18.5 months).

CONCLUSIONS

MWA combined with POP is an effective and safe treatment for pelvic osteolytic metastases. It can significantly relieve local pain, reconstruct limb function, improve patients' quality of life, and effectively control local tumour progression.

ADVANCES IN KNOWLEDGE

So far, the experience of using microwave in the treatment of pelvic metastases is still limited. MWA combined with POP in the treatment of pelvic osteolytic metastases can provide significant clinical benefits in acceptable low-risk minimally invasive situations and should be provided to patients with appropriate pelvic metastases in a multidisciplinary approach.

Percutaneous Osteoplasty for the Management of a Talar Metastasis: A Case Report

Background

Talar metastasis is very rare among all bone metastases. Routine radiotherapy and chemotherapy are the main treatment measures at present. Nevertheless, some patients still experience unbearable cancer pain that cannot be effectively relieved with powerful painkillers.

Case Report

We report a patient with advanced renal carcinoma suffering from unbearable pain due to multiple bone metastases that involved several vertebrae (T11, L1, and L2) and the left talus. After percutaneous vertebroplasty in the vertebrae, the pain in the left talus became more prominent. We performed a percutaneous osteoplasty to manage the talar metastasis. Postoperatively, the pain level remarkably decreased, and the patient’s activity capacity significantly improved.

Conclusion

Percutaneous osteoplasty is an alternative method for talar metastasis that can alleviate pain immediately and improve the quality of life in patients with advanced malignant tumors.

Percutaneous microwave ablation with osteoplasty and interventional internal fixation for impending pathologic fracture of the proximal humerus

Humerus is the long bone second-most commonly affected by metastases. An impending pathologic humeral fracture requires rigid surgical stabilization to prevent it from fully fracturing. In the present study, we report a case of a 71-year-old male patient with a visual analog score of 10 (indicating extreme pain) and an impending pathologic fracture that allowed for combined treatment with percutaneous microwave ablation and simultaneous injection of bone cement during Kirschner wire insertion. The procedure was performed successfully with no complications. The patient reported pain relief and improved quality of life and functional status 1 day, 7 days, 1 month, and 2 months after his procedure.

Percutaneous osteoplasty for the management of a humeral head metastasis: Two case reports

RATIONALE

Percutaneous osteoplasty (POP) has been proved effective to relieve pain in metastases of vertebral, pelvis, and femur. Nevertheless, there are few reports about the effectiveness of POP in the humeral head metastases. In this study, we described 2 patients with humeral head metastases treated with POP in our hospital.

PATIENT CONCERNS

Case 1 was a 79-year-old man with vertebral and right humeral head metastasis after radical surgery or and periods of chemotherapy for bladder cancer. He suffered constant severe back and right shoulder joint pain even if taking much non-steroidal anti-inflammatory drugs. Case 2 was a 59-year-old woman with vertebral and right humeral head metastasis from lung cancer. She received regular radiotherapy and took much painkillers to relieve pain. However, the pain could not be relieved any more after 1 month and severely affects sleeping and daily activities.

DIAGNOSIS

Both 2 patients were diagnosed as vertebral metastases and right proximal humeral head metastases.

INTERVENTIONS

POP was performed to treat the right humeral head metastases. Percutaneous vertebroplasty (PVP) was performed to treat vertebral metastases.

OUTCOMES

After surgery, the patients experienced significant decrease in pain and better motor function. Both patients did not suffer from pulmonary embolism, infection, nerve injury, and bone cement syndrome.

LESSONS

For the pain that cannot be relieved by radiotherapy and analgesic drugs, POP is a safe and beneficial minimally invasive procedure that provides immediate and substantial relief from pain for humerus head metastases.

Percutaneous osteoplasty for extraspinal metastases

As an extension of percutaneous vertebroplasty (PVP), percutaneous osteoplasty (POP) refers broadly to percutaneous bone cement injected into various parts of the body and narrowly to cement injected into extraspinal bone lesions. POP mainly includes such surgeries as percutaneous sacroplasty, percutaneous acetabuloplasty, percutaneous femoral osteoplasty, and percutaneous iliac osteoplasty (Figure 1). Currently, POP is a positive and an effective treatment for extraspinal bone lesions in that it can rapidly relieve pain, effectively prevent pathological fractures, and partially inactivate tumors, with few complications. The aim of this review is to detail the POP techniques and report their safety and efficacy in the treatment of extraspinal metastases.