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Palliative Arterial Embolization for Metastases of the Sternum

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  • Musculoskeletal Interventions
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Abstract

Background

To investigate the safety and efficacy of palliative arterial embolization for metastases of the sternum.

Materials and Methods

This study included 10 consecutive patients (5 M, 5 F; mean age 58.1; range 37–70) with metastases of the sternum from different primary tumors, treated with palliative arterial embolization using NBCA-Lipiodol between January 2007 and June 2022. Four patients received a second embolization at the same site, for a total of 14 embolizations. Data on technical and clinical success, as well as changes in tumor size, were collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications.

Results

Post-embolization angiography showed occlusion of more than 90% of the pathological feeding vessels in all procedures. Pain score and analgesic drug consumption were reduced by 50% in all 10 patients (100%, p < 0.05). The mean duration of pain relief was 9.5 months (range 8 to 12 months, p < 0.05). Metastatic tumor size was reduced from a mean of 71.5 cm3 (range 41.6 to 90.3 cm3) pre-embolization to a mean of 67.9 cm3 (range 38.5 to 86.1 cm3) at the 12-month follow-up (p < 0.05). None of the patients experienced embolization-related complications.

Conclusion

Arterial embolization is safe and effective as a palliative treatment for patients with metastases of the sternum who did not benefit from radiation therapy or experienced recurrence in symptoms.

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References

  1. D’Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic bone disease: pathogenesis and therapeutic options: up-date on bone metastasis management. J Bone Oncol. 2019;15:004–004.

    PubMed  Google Scholar 

  2. Coleman RE, Croucher PI, Padhani AR, et al. Bone metastases. Nat Rev Dis Primers. 2020;6(1):83.

    Article  PubMed  Google Scholar 

  3. Migliorini F, Maffulli N, Trivellas A, Eschweiler J, Tingart M, Driessen A. Bone metastases: a comprehensive review of the literature. Mol Biol Rep. 2020;47(8):6337–45.

    Article  CAS  PubMed  Google Scholar 

  4. Buenrostro D, Mulcrone PL, Owens P, Sterling JA. The bone microenvironment: a fertile soil for tumor growth. Curr Osteoporos Rep. 2016;14(4):151–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Macedo F, Ladeira K, Pinho F, et al. Bone metastases: an overview. Oncol Rev. 2017;11(1):321.

    PubMed  PubMed Central  Google Scholar 

  6. Koizumi M, Yoshimoto M, Kasumi F, Ogata E. Comparison between solitary and multiple skeletal metastatic lesions of breast cancer patients. Ann Oncol. 2003;14(8):1234–40.

    Article  CAS  PubMed  Google Scholar 

  7. Sponholz S, Baldes N, Schirren M, Oguzhan S, Menke H, Schirren J. Sternal resection for breast cancer metastases. Thorac Cardiovasc Surg. 2018;66(2):164–9.

    Article  PubMed  Google Scholar 

  8. Kakhki VRD, 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(2):66–9.

    Article  PubMed  Google Scholar 

  9. Wang C, Shen Y, Zhu S. Distribution features of skeletal metastases: a comparative study between pulmonary and prostate cancers. PLoS ONE. 2015;10(11): e0143437.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhu M, Liu X, Qu Y, et al. Bone metastasis pattern of cancer patients with bone metastasis but no visceral metastasis. J Bone Oncol. 2019;15: 100219.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hong S, Youk T, Lee SJ, Kim KM, Vajdic CM. Bone metastasis and skeletal-related events in patients with solid cancer: A Korean nationwide health insurance database study. PLoS ONE. 2020;15(7): e0234927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Papalexis N, Parmeggiani A, Peta G, Spinnato P, Miceli M, Facchini G. Minimally invasive interventional procedures for metastatic bone disease: a comprehensive review. Curr Oncol. 2022;29(6):4155–77.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Marciel AM, Van Zandt BL, Baxter AJ. Transcatheter arterial embolization for the palliation of painful bone lesions. Tech Vasc Interv Radiol. 2011;14(3):141–9.

    Article  PubMed  Google Scholar 

  14. Filippiadis DK, Cornelis FH, Kelekis A. Interventional oncologic procedures for pain palliation. Presse Med. 2019;48(7–8 Pt 2):e251–6.

    Article  PubMed  Google Scholar 

  15. Rossi G, Mavrogenis AF, Rimondi E, Braccaioli L, Calabrò T, Ruggieri P. Selective embolization with N-butyl cyanoacrylate for metastatic bone disease. J Vasc Interv Radiol. 2011;22(4):462–70.

    Article  PubMed  Google Scholar 

  16. Heianna J, Makino W, Toguchi M, et al. Transarterial chemoembolization for the palliation of painful bone metastases refractory to first-line radiotherapy. J Vasc Interv Radiol. 2021;32(3):384–92.

    Article  PubMed  Google Scholar 

  17. Rossi G, Mavrogenis AF, Rimondi E, et al. Selective arterial embolisation for bone tumours: experience of 454 cases. Radiol Med. 2011;116(5):793–808.

    Article  CAS  PubMed  Google Scholar 

  18. Rossi G, Mavrogenis AF, Casadei R, et al. Embolisation of bone metastases from renal cancer. Radiol Med. 2013;118(2):291–302.

    Article  CAS  PubMed  Google Scholar 

  19. Koike Y, Takizawa K, Ogawa Y, et al. Transcatheter arterial chemoembolization (TACE) or embolization (TAE) for symptomatic bone metastases as a palliative treatment. Cardiovasc Intervent Radiol. 2011;34(4):793–801.

    Article  PubMed  Google Scholar 

  20. Chiras J, Adem C, Vallée JN, Spelle L, Cormier E, Rose M. Selective intra-arterial chemoembolization of pelvic and spine bone metastases. Eur Radiol. 2004;14(10):1774–80.

    Article  PubMed  Google Scholar 

  21. Pazionis TJC, Papanastassiou ID, Maybody M, Healey JH. Embolization of hypervascular bone metastases reduces intraoperative blood loss: a case-control study. Clin Orthop Relat Res. 2014;472(10):3179–87.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim W, Han I, Jae HJ, et al. Preoperative embolization for bone metastasis from hepatocellular carcinoma. Orthopedics. 2015;38(2):e99–105.

    Article  PubMed  Google Scholar 

  23. Ma J, Tullius T, Van Ha TG. Update on preoperative embolization of bone metastases. Semin Intervent Radiol. 2019;36(3):241–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Facchini G, Di Tullio P, Battaglia M, et al. Palliative embolization for metastases of the spine. Eur J Orthop Surg Traumatol. 2016;26(3):247–52.

    Article  PubMed  Google Scholar 

  25. Owen RJT. Embolization of musculoskeletal bone tumors. Semin Intervent Radiol. 2010;27(2):111–23.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Börüban S, Sancak T, Yildiz Y, Sağlik Y. Embolization of benign and malignant bone and soft tissue tumors of the extremities. Diagn Interv Radiol. 2007;13(3):164–71.

    PubMed  Google Scholar 

  27. Wong SJ, Urlings T, Seng C, Leong S, Tan BS, Tan MH. Pre-operative embolisation of musculoskeletal tumours - a single centre experience. Malays Orthop J. 2020;14(1):42–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40(8):1141–6.

    Article  CAS  PubMed  Google Scholar 

  29. Butterworth JA, Garvey PB, Baumann DP, Zhang H, Rice DC, Butler CE. Optimizing reconstruction of oncologic sternectomy defects based on surgical outcomes. J Am Coll Surg. 2013;217(2):306–16.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51(1):10–29.

    Article  PubMed  Google Scholar 

  31. Piggott RP, Curtin M, Munigangaiah S, Jadaan M, McCabe JP, Devitt A. Sternal metastasis - the forgotten column and its effect on thoracic spine stability. World J Orthop. 2017;8(6):455–60.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M. Radiation-induced lung injury: assessment and management. Chest. 2019;156(1):150–62.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med. 2021;21(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol. 2020;27(2):107–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Benveniste MF, Gomez D, Carter BW, Betancourt Cuellar SL, De Groot PM, Marom EM. Radiation effects in the mediastinum and surroundings: imaging findings and complications. Semin Ultrasound CT MR. 2016;37(3):268–80.

    Article  PubMed  Google Scholar 

  36. Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE. Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol. 2003;45(1):55–75.

    Article  PubMed  Google Scholar 

  37. Gaya AM, Ashford RFU. Cardiac complications of radiation therapy. Clin Oncol. 2005;17(3):153–9.

    Article  CAS  Google Scholar 

  38. Adams MJ, Lipshultz SE, Schwartz C, Fajardo LF, Coen V, Constine LS. Radiation-associated cardiovascular disease: manifestations and management. Semin Radiat Oncol. 2003;13(3):346–56.

    Article  PubMed  Google Scholar 

  39. Autrusseau PA, Garnon J, Auloge P, et al. Hydrodissection of the retro-sternal space to protect the pericardium during sternal cryoablation. Cardiovasc Intervent Radiol. 2020;43(9):1371–7.

    Article  PubMed  Google Scholar 

  40. Hegg RM, Kurup AN, Schmit GD, et al. Cryoablation of sternal metastases for pain palliation and local tumor control. J Vasc Interv Radiol. 2014;25(11):1665–70.

    Article  PubMed  Google Scholar 

  41. Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol. 2014;43(11):1551–9.

    Article  PubMed  Google Scholar 

  42. Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol. 2019;48(8):1161–9.

    Article  PubMed  Google Scholar 

  43. Chang EM, Shaverdian N, Capiro N, Steinberg ML, Raldow AC. Cost effectiveness of external beam radiation therapy versus percutaneous image-guided cryoablation for palliation of uncomplicated bone metastases. J Vasc Interv Radiol. 2020;31(8):1221–32.

    Article  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Nicolas Papalexis, Giuliano Peta, Giulio Vara, Paolo Spinnato, Claudia Martella, Marco Miceli & Giancarlo Facchini

  2. Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Costantino Errani & Claudia Martella

Authors
  1. Nicolas Papalexis
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  2. Giuliano Peta
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  3. Giulio Vara
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  4. Paolo Spinnato
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  7. Marco Miceli
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Correspondence to Nicolas Papalexis.

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Papalexis, N., Peta, G., Vara, G. et al. Palliative Arterial Embolization for Metastases of the Sternum. Cardiovasc Intervent Radiol 46, 794–798 (2023). https://doi.org/10.1007/s00270-023-03459-1

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  • DOI: https://doi.org/10.1007/s00270-023-03459-1

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