Abstract
Purpose
The aim of this study was to demonstrate the effectiveness of interventional techniques in the palliative management of painful extraspinal bone metastases.
Materials and methods
Cementoplasty alone or in combination with radiofrequency (RF) ablation was performed in 14 skeletal extravertebral segments in 13 patients with ages ranging from 50 to 74 (average 67) years. The primary tumours were myeloma (n=5), renal carcinoma (n=5), hepatocellular carcinoma (n=2) and bladder carcinoma (n=2). Metastases were located at the acetabulum (n=4), femur (n=5), humerus (n=1), scapula (n=2) and iliac bone (n=2). The clinical indication was a pain intensity score >4 on the visual analogue scale (VAS) partially or totally refractory to analgesic medication. Clinical evaluation was based on clinical and neurological conditions before and immediately after the procedure and during the follow-up.
Results
Technical success was achieved in all cases. Ten patients were treated by cementoplasty alone and four cases by cementoplasty combined with RF ablation. After treatment, all patients experienced improved symptoms, as demonstrated by the VAS score, which remained constant during follow-up. All patients were followed for between 2 and 14 (average 6.1) months. We had one major complication in a patient who developed an abscess, which was treated by percutaneous drainage.
Conclusions
In our experience, cementoplasty alone for small lesions or combined with RF ablation in larger lesions is an effective and safe therapy in the palliative management of painful extraspinal bone metastases.
Riassunto
Obiettivo
Scopo del nostro lavoro è quello di riportare la nostra esperienza nel trattamento palliativo delle metastasi ossee extra-spinali mediante cementoplastica da sola o in combinazione con l’ablazione a radiofrequenze (RF).
Materiali e metodi
Sono state trattate con cementoplastica 14 lesioni in 13 pazienti con età compresa tra 50 e 74 anni, media 67 anni, quattro di queste precedute dalla ablazione con RF; le neoplasie primitive erano mieloma (n=5), carcinoma renale (n=5), carcinoma epatocellulare (n=2), carcinoma vescicale (n=2). Le lesioni erano localizzate all’acetabolo (n=4), al femore (n=5), all’omero (n=1), alla scapola (n=2) ed all’osso iliaco (n=2). L’indicazione clinica al trattamento è stata data dalla presenza di un valore della visual analogue scale (VAS) superiore a 5, refrattario o parzialmente refrattario al trattamento con analgesici. La valutazione clinica è stata basata sulle condizioni generali e neurologiche dei pazienti prima, immediatamente dopo e durante i follow-up.
Risultati
Il successo tecnico della procedura è stato ottenuto in tutti i casi. In 10 pazienti è stata eseguita la sola cementoplastica mentre in 3 pazienti rispettivamente con grossa metastasi scapolare successivamente recidivata e con masse osteolitiche all’osso iliaco, la cementoplastica è stata preceduta dalla ablazione con RF. Tutti i pazienti hanno avvertito un miglioramento della sintomatologia immediatamente dopo la procedura riscontrato in una riduzione del valore VAS rimasto pressoché costante durante i follow-up successivi. Il follow-up è stato ottenuto in tutti i pazienti ed è variato da 2 a 14 mesi (media: 6,1). Abbiamo avuto una sola complicanza in un paziente che ha sviluppato un ascesso nella sede di intervento drenato percutaneamente.
Conclusioni
Nella nostra esperienza la cementoplastica, da sola in lesioni di piccole dimensioni o preceduta dalla ablazione con RF per lesioni di maggiori dimensioni rappresenta una efficace terapia nel trattamento del dolore derivante da metastasi ossee extra-spinali.
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Basile, A., Giuliano, G., Scuderi, V. et al. Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol med 113, 1018–1028 (2008). https://doi.org/10.1007/s11547-008-0314-1
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DOI: https://doi.org/10.1007/s11547-008-0314-1