Subscribe to RSS
DOI: 10.1055/s-0042-1745787
Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases
![](https://www.thieme-connect.de/media/sir/202202/lookinside/thumbnails/10-1055-s-0042-1745787_001369-1.jpg)
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.
Keywords
musculoskeletal oncology - thermal ablation - cementoplasty - osteosynthesis - thermal protection - neurolysis - interventional radiologyPublication History
Article published online:
30 June 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Macedo F, Ladeira K, Pinho F. et al. Bone metastases: an overview. Oncol Rev 2017; 11 (01) 321
- 2 Urch C. The pathophysiology of cancer-induced bone pain: current understanding. Palliat Med 2004; 18 (04) 267-274
- 3 Schulman KL, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer 2007; 109 (11) 2334-2342
- 4 Deschavanne PJ, Fertil B. A review of human cell radiosensitivity in vitro. Int J Radiat Oncol Biol Phys 1996; 34 (01) 251-266
- 5 Strander H, Turesson I, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003; 42 (5-6): 516-531
- 6 van der Linden YM, Steenland E, van Houwelingen HC. et al; Dutch Bone Metastasis Study Group. Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: results on survival in the Dutch Bone Metastasis Study. Radiother Oncol 2006; 78 (03) 245-253
- 7 World Health Organization (WHO). WHO's cancer pain ladder for adults. Published November 27, 2013. Accessed December 26, 2020 at: www.whoint/cancer/palliative/painladder/en/
- 8 Paice JA. Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management. Cancer 2018; 124 (12) 2491-2497
- 9 Dupuy DE, Liu D, Hartfeil D. et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer 2010; 116 (04) 989-997
- 10 Anchala PR, Irving WD, Hillen TJ. et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician 2014; 17 (04) 317-327
- 11 Bagla S, Sayed D, Smirniotopoulos J. et al. Multicenter prospective clinical series evaluating radiofrequency ablation in the treatment of painful spine metastases. Cardiovasc Intervent Radiol 2016; 39 (09) 1289-1297
- 12 Tomasian A, Hillen TJ, Chang RO, Jennings JW. Simultaneous bipedicular radiofrequency ablation combined with vertebral augmentation for local tumor control of spinal metastases. AJNR Am J Neuroradiol 2018; 39 (09) 1768-1773
- 13 Wallace AN, Tomasian A, Vaswani D, Vyhmeister R, Chang RO, Jennings JW. Radiographic local control of spinal metastases with percutaneous radiofrequency ablation and vertebral augmentation. AJNR Am J Neuroradiol 2016; 37 (04) 759-765
- 14 Tomasian A, Wallace A, Northrup B, Hillen TJ, Jennings JW. Spine cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR Am J Neuroradiol 2016; 37 (01) 189-195
- 15 Callstrom MR, Dupuy DE, Solomon SB. et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 2013; 119 (05) 1033-1041
- 16 Wallace AN, McWilliams SR, Connolly SE. et al. Percutaneous image-guided cryoablation of musculoskeletal metastases: pain palliation and local tumor control. J Vasc Interv Radiol 2016; 27 (12) 1788-1796
- 17 Callstrom MR, Atwell TD, Charboneau JW. et al. Painful metastases involving bone: percutaneous image-guided cryoablation–prospective trial interim analysis. Radiology 2006; 241 (02) 572-580
- 18 Auloge P, Cazzato RL, Rousseau C. et al. Complications of percutaneous bone tumor cryoablation: a 10-year experience. Radiology 2019; 291 (02) 521-528
- 19 Deib G, Deldar B, Hui F, Barr JS, Khan MA. Percutaneous microwave ablation and cementoplasty: clinical utility in the treatment of painful extraspinal osseous metastatic disease and myeloma. AJR Am J Roentgenol 2019; 27: 1-8
- 20 Khan MA, Deib G, Deldar B, Patel AM, Barr JS. Efficacy and safety of percutaneous microwave ablation and cementoplasty in the treatment of painful spinal metastases and myeloma. AJNR Am J Neuroradiol 2018; 39 (07) 1376-1383
- 21 Tomasian A, Gangi A, Wallace AN, Jennings JW. Percutaneous thermal ablation of spinal metastases: recent advances and review. AJR Am J Roentgenol 2018; 210 (01) 142-152
- 22 Tomasian A, Jennings JW. Percutaneous minimally invasive thermal ablation of osseous metastases: evidence-based practice guidelines. AJR Am J Roentgenol 2020; 215 (02) 502-510
- 23 McMenomy BP, Kurup AN, Johnson GB. et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol 2013; 24 (02) 207-213
- 24 Luigi Cazzato R, Auloge P, De Marini P. et al. Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients. Int J Hyperthermia 2018; 35 (01) 493-499
- 25 Napoli A, Anzidei M, Marincola BC. et al. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Invest Radiol 2013; 48 (06) 351-358
- 26 Hurwitz MD, Ghanouni P, Kanaev SV. et al. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. J Natl Cancer Inst 2014; 106 (05) dju082
- 27 Scipione R, Anzidei M, Bazzocchi A, Gagliardo C, Catalano C, Napoli A. HIFU for bone metastases and other musculoskeletal applications. Semin Intervent Radiol 2018; 35 (04) 261-267
- 28 Tsai YC, Lee HL, Kuo CC. et al. Prognostic and predictive factors for clinical and radiographic responses in patients with painful bone metastasis treated with magnetic resonance-guided focused ultrasound surgery. Int J Hyperthermia 2019; 36 (01) 932-937
- 29 Levy J, Hopkins T, Morris J. et al. Radiofrequency ablation for the palliative treatment of bone metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 patients. J Vasc Interv Radiol 2020; 31 (11) 1745-1752
- 30 Mehta TI, Heiberger C, Kazi S. et al. Effectiveness of radiofrequency ablation in the treatment of painful osseous metastases: a correlation meta-analysis with machine learning cluster identification. J Vasc Interv Radiol 2020; 31 (11) 1753-1762
- 31 Tomasian A, Jennings JW. Percutaneous interventional techniques for treatment of spinal metastases. Semin Intervent Radiol 2020; 37 (02) 192-198
- 32 Lee FY, Latich I, Toombs C. et al. Minimally invasive image-guided ablation, osteoplasty, reinforcement, and internal fixation (AORIF) for osteolytic lesions in the pelvis and periarticular regions of weight-bearing bones. J Vasc Interv Radiol 2020; 31 (04) 649-658.e1
- 33 Deschamps F, de Baere T, Hakime A. et al. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 2016; 26 (06) 1631-1639
- 34 Cornelis FH, Deschamps F. Augmented osteoplasty for proximal femur consolidation in cancer patients: Biomechanical considerations and techniques. Diagn Interv Imaging 2017; 98 (09) 645-650
- 35 Pusceddu C, Fancellu A, Ballicu N, Fele RM, Sotgia B, Melis L. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol 2017; 46 (04) 539-545
- 36 Buy X, Catena V, Roubaud G, Crombe A, Kind M, Palussiere J. Image-guided bone consolidation in oncology. Semin Intervent Radiol 2018; 35: 221-228
- 37 Garnon J, Jennings JW, Meylheuc L. et al. Biomechanics of the osseous pelvis and its implication for consolidative treatments in interventional oncology. Cardiovasc Intervent Radiol 2020; 43 (11) 1589-1599
- 38 Cazzato RL, Palussière J, Auloge P. et al. Complications following percutaneous image-guided radiofrequency ablation of bone tumors: a 10-year dual-center experience. Radiology 2020; 296 (01) 227-235
- 39 Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol 2016; 39 (01) 74-80
- 40 Filippiadis DK, Tselikas L, Bazzocchi A, Efthymiou E, Kelekis A, Yevich S. Percutaneous management of cancer pain. Curr Oncol Rep 2020; 22 (05) 43
- 41 Ahmed O, Feinberg N, Lea WB. Interventional techniques for the ablation and augmentation of extraspinal lytic bone metastases. Semin Intervent Radiol 2019; 36 (03) 221-228
- 42 Cazzato RL, Buy X, Grasso RF. et al. Interventional radiologist's perspective on the management of bone metastatic disease. Eur J Surg Oncol 2015; 41 (08) 967-974
- 43 Lis E, Laufer I, Barzilai O. et al. Change in the cross-sectional area of the thecal sac following balloon kyphoplasty for pathological vertebral compression fractures prior to spine stereotactic radiosurgery. J Neurosurg Spine 2018; 30 (01) 111-118
- 44 Garnon J, Meylheuc L, Cazzato RL. et al. Percutaneous extra-spinal cementoplasty in patients with cancer: a systematic review of procedural details and clinical outcomes. Diagn Interv Imaging 2019; 100 (12) 743-752
- 45 Venier A, Roccatagliata L, Isalberti M. et al. Armed kyphoplasty: an indirect central canal decompression technique in burst fractures. AJNR Am J Neuroradiol 2019; 40 (11) 1965-1972
- 46 Bittman RW, Peters GL, Newsome JM. et al. Percutaneous image-guided cryoneurolysis. AJR Am J Roentgenol 2018; 210 (02) 454-465
- 47 Bittman RW, Behbahani K, Gonzalez F, Prologo JD. Interventional cryoneurolysis: What is the same, what is different, what is new?. Semin Intervent Radiol 2019; 36 (05) 374-380
- 48 Prologo JD, Patel I, Buethe J, Bohnert N. Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol 2014; 25 (05) 769-775.e2
- 49 Filippiadis DK, Tselikas L, Tsitskari M, Kelekis A, de Baere T, Ryan AG. Percutaneous neurolysis for pain management in oncological patients. Cardiovasc Intervent Radiol 2019; 42 (06) 791-799
- 50 National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: adult cancer pain, version 2. 2021 . Accessed December 19, 2020 at: www.nccn.org
- 51 Shah LM, Jennings JW, Kirsch CFE. et al; Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging. ACR Appropriateness Criteria® management of vertebral compression fractures. J Am Coll Radiol 2018; 15 (11S, Suppl 11): S347-S364
- 52 Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2 (03) 187-193
- 53 Dupuy DE, Hong R, Oliver B, Goldberg SN. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. AJR Am J Roentgenol 2000; 175 (05) 1263-1266
- 54 Singh S, Saha S. Electrical properties of bone. A review. Clin Orthop Relat Res 1984; (186) 249-271
- 55 Vaswani D, Wallace AN, Eiswirth PS. et al. Radiographic local tumor control and pain palliation of sarcoma metastases within the musculoskeletal system with percutaneous thermal ablation. Cardiovasc Intervent Radiol 2018; 41 (08) 1223-1232
- 56 Ma Y, Wallace AN, Waqar SN. et al. Percutaneous image-guided ablation in the treatment of osseous metastases from non-small cell lung cancer. Cardiovasc Intervent Radiol 2018; 41 (05) 726-733
- 57 Weld KJ, Landman J. Comparison of cryoablation, radiofrequency ablation and high-intensity focused ultrasound for treating small renal tumours. BJU Int 2005; 96 (09) 1224-1229
- 58 Jennings JW, Prologo JD, Garnon J. et al. Cryoablation for palliation of painful bone metastases: the MOTION multicenter study. Radiol Imaging Cancer 2021; 3 (02) e200101
- 59 Kurup AN, Morris JM, Schmit GD. et al. Neuroanatomic considerations in percutaneous tumor ablation. Radiographics 2013; 33 (04) 1195-1215
- 60 Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol 2013; 36 (06) 1624-1628
- 61 Kurup AN, Morris JM, Boon AJ. et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol 2014; 25 (11) 1657-1664
- 62 Buy X, Tok CH, Szwarc D, Bierry G, Gangi A. Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol 2009; 32 (03) 529-534
- 63 Li Z, Butala NB, Etheridge BS, Siegel HJ, Lemons JE, Eberhardt AW. A biomechanical study of periacetabular defects and cement filling. J Biomech Eng 2007; 129 (02) 129-136
- 64 Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D. Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol 2008; 31 (06) 1165-1173
- 65 Vaishya R, Chauhan M, Vaish A. Bone cement. J Clin Orthop Trauma 2013; 4 (04) 157-163
- 66 Dalton BE, Kohm AC, Miller LE, Block JE, Poser RD. Radiofrequency-targeted vertebral augmentation versus traditional balloon kyphoplasty: radiographic and morphologic outcomes of an ex vivo biomechanical pilot study. Clin Interv Aging 2012; 7: 525-531
- 67 Kurup AN, Morris JM, Schmit GD. et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol 2015; 26 (04) 588-594
- 68 Hsu M, Stevenson FF. Wallerian degeneration and recovery of motor nerves after multiple focused cold therapies. Muscle Nerve 2015; 51 (02) 268-275
- 69 Jones WB, Jordan P, Pudi M. Pain management of pancreatic head adenocarcinomas that are unresectable: celiac plexus neurolysis and splanchnicectomy. J Gastrointest Oncol 2015; 6 (04) 445-451