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DOI: 10.1055/s-0039-1693117
Interventional Techniques for the Ablation and Augmentation of Extraspinal Lytic Bone Metastases
Publication History
Publication Date:
19 August 2019 (online)
![](https://www.thieme-connect.de/media/sir/201903/lookinside/thumbnails/10-1055-s-0039-1693117_001148-1.jpg)
Abstract
In addition to being a major source of cancer-related pain, metastatic osseous lesions are frequently at risk for pathologic fracture and its accompanying morbidity. While bony metastases are commonly thought of as occurring within the vertebral column, over 80% are found outside the spine. Percutaneous interventional treatment options for nonspinal metastases offer a broad array of minimally invasive, image-guided procedures that are rapidly effective, reduce the need for opioids, and often work in complementary fashion with adjunct treatments in radiation oncology, orthopaedic surgery, and/or medical oncology. This article presents an approach to assess extraspinal metastases, reviews available interventional techniques in use today, and offers example cases as an introductory primer to the thought process used for selecting the appropriate interventional treatment.
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References
- 1 Macedo F, Ladeira K, Pinho F. , et al. Bone metastases: an overview. Oncol Rev 2017; 11 (01) 321
- 2 Munk PL, Rashid F, Heran MK. , et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 2009; 20 (07) 903-911
- 3 Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M. Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev Cent East Eur 2013; 16 (02) 66-69
- 4 Goetz MP, Callstrom MR, Charboneau JW. , et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 2004; 22 (02) 300-306
- 5 Gilbert HA, Kagan AR, Nussbaum H. , et al. Evaluation of radiation therapy for bone metastases: pain relief and quality of life. AJR Am J Roentgenol 1977; 129 (06) 1095-1096
- 6 Hoskin PJ. Palliation of bone metastases. Eur J Cancer 1991; 27 (08) 950-951
- 7 Janjan NA. Radiation for bone metastases: conventional techniques and the role of systemic radiopharmaceuticals. Cancer 1997; 80 (8, Suppl): 1628-1645
- 8 Hayashi S, Hoshi H, Iida T. Reirradiation with local-field radiotherapy for painful bone metastases. Radiat Med 2002; 20 (05) 231-236
- 9 Motamedi K, Levine BD, Bukata SV, Genshaft S. Percutaneous image-guided musculoskeletal tumor treatments. AJR Am J Roentgenol 2016; 207 (03) 517-525
- 10 WHO's Cancer Pain Ladder for Adults. World Health Organization, World Health Organization, November 27, 2013. Available at: www.who.int/cancer/palliative/painladder/en/ . Accessed June 13, 2019
- 11 Cazzato RL, Palussière J, Buy X. , et al. Percutaneous long bone cementoplasty for palliation of malignant lesions of the limbs: a systematic review. Cardiovasc Intervent Radiol 2015; 38 (06) 1563-1572
- 12 Mesko NW, Joshua LM, Steven AL. Minimally invasive techniques for pain palliation in extraspinal bone metastases. Curr Orthop Pract 2016; 27 (06) 686-695
- 13 Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging 2017; 98 (06) 483-489
- 14 Kelekis A, Filippiadis D, Anselmetti G. , et al. Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the Rebar concept. Cardiovasc Intervent Radiol 2016; 39 (01) 90-96
- 15 Callstrom MR, Charboneau JW, Goetz MP. , et al. Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation. Radiology 2002; 224 (01) 87-97
- 16 Carrafiello G, Laganà D, Ianniello A. , et al. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma. Eur J Radiol 2009; 71 (02) 363-368
- 17 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
- 18 Guenette JP, Lopez MJ, Kim E, Dupuy DE. Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter American College of Radiology Imaging Network Study. Radiology 2013; 268 (03) 907-915
- 19 Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee Jr FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why?. Radiographics 2014; 34 (05) 1344-1362
- 20 Tatli S, Tapan U, Morrison PR, Silverman SG. Radiofrequency ablation: technique and clinical applications. Diagn Interv Radiol 2011; 18 (05) 508-516
- 21 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
- 22 Gardner CS, Ensor JE, Ahrar K. , et al. Cryoablation of bone metastases from renal cell carcinoma for local tumor control. J Bone Joint Surg Am 2017; 99 (22) 1916-1926
- 23 Cazzato RL, Garnon J, Shaygi B. , et al. Percutaneous consolidation of bone metastases: strategies and techniques. Insights Imaging 2019; 10 (01) 14
- 24 Gangi A, Buy X. Percutaneous bone tumor management. Semin Intervent Radiol 2010; 27 (02) 124-136
- 25 Basile A, Giuliano G, Scuderi V. , et al. Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med (Torino) 2008; 113 (07) 1018-1028
- 26 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
- 27 Liu XW, Jin P, Liu K. , et al. Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture. Eur Radiol 2017; 27 (01) 120-127
- 28 Kim YI, Kang HG, Kim TS, Kim SK, Kim JH, Kim HS. Palliative percutaneous stabilization of lower extremity for bone metastasis using flexible nails and bone cement. Surg Oncol 2014; 23 (04) 192-198
- 29 Angelini A, Trovarelli G, Ruggieri P. Metastases to the pelvis: algorithm of treatment. Management of Bone Metastases 2018; 103-113
- 30 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
- 31 Piccioli A, Spinelli MS, Maccauro G. Impending fracture: a difficult diagnosis. Injury 2014; 45 (Suppl. 06) S138-S141
- 32 Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 2012; 35 (06) 1428-1432
- 33 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; 1-8
- 34 Gupta AC, Hirsch JA, Chaudhry ZA. , et al. Evaluating the safety and effectiveness of percutaneous acetabuloplasty. J Neurointerv Surg 2012; 4 (02) 134-138
- 35 Harrington KD. The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg Am 1981; 63 (04) 653-664
- 36 Van der Linden YM, Dijkstra PD, Kroon HM. , et al. Comparative analysis of risk factors for pathological fracture with femoral metastases. J Bone Joint Surg Br 2004; 86 (04) 566-573
- 37 Harrington KD. New trends in the management of lower extremity metastases. Clin Orthop Relat Res 1982; (169) 53-61