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Selective arterial embolisation for bone tumours: experience of 454 cases

L’embolizzazione arteriosa selettiva dei tumori ossei: esperienza in 454 casi

La radiologia medica volume 116, pages 793–808 (2011)Cite this article

Abstract

Purpose

The authors present the experience of a single institution with selective arterial embolisation for primary and metastatic bone tumours.

Materials and methods

A total of 365 patients were treated with 454 embolisation procedures from December 2002 to April 2010. Embolisation was the primary treatment for benign bone tumours, adjuvant treatment to surgery for benign and malignant bone tumours and palliative treatment for bone sarcomas and metastases. Indications for repeat embolisation included pain or imaging evidence of progressive disease: 105 patients had repeat embolisation at the same location at an interval of 1–3 months; 260 patients had one embolisation, 78 had two and 29 had three or more. In all patients, N-2-butyl cyanoacrylate (NBCA) in 33% lipiodol was the embolic agent used.

Results

A total of 419 of the 454 embolisations (93%) were technically successful. In 35 cases, embolisation was not feasible because of poor lesion vascularisation (21 patients with bone metastases and two with aneurysmal bone cysts), origin of the Adamkiewicz artery in the embolisation field (four patients with bone metastases and one with aneurysmal bone cyst), atheromatosis and arteriosclerosis (five patients with bone metastases) and anatomical and technical problems such as small-calibre vessels, many branches and acute vessel angles (two patients with bone metastases). A clinical response was achieved in 406 of the 419 procedures (97%), and no response in 13 procedures in patients with pelvis and sacrum tumours. Complications included postembolisation syndrome in 81 patients (22%), transient paraesthesias in 41 (11%), skin breakdown and subcutaneous necrosis at the shoulder and pelvis in five (1.4%) and paresis of the sciatic nerve in one (0.3%).

Conclusions

We recommend embolisation as primary or palliative treatment or an adjunct to surgery for tumours of variable histology. Strict adherence to the principles of transcatheter embolisation is important. Arteries feeding the tumour and collaterals must be evaluated carefully and catheterised superselectively to protect the normal tissues. NBCA is considered the most appropriate embolic agent for small-vessel occlusion without major complications.

Riassunto

Obiettivo

Scopo del nostro lavoro è presentare l’esperienza di una singola istituzione nell’embolizzazione arteriosa selettiva dei tumori primitivi e delle metastasi dell’apparato muscolo-scheletrico.

Materiali e metodi

Trecentosessantacinque pazienti sono stati sottoposti a 454 embolizzazioni da dicembre 2002 a aprile 2010. L’embolizzazione è stata usata come trattamento primario per pseudo-tumori e tumori benigni, con significato adiuvante nel trattamento dei tumori maligni e nelle forme benigne e con significato palliativo nel trattamento dei sarcomi dell’osso e delle lesioni metastatiche. Il dolore e l’evidenza all’imaging di una progressione di malattia era l’indicazione per la ripetizione dell’embolizzazione; 105 hanno ripetuto l’embolizzazione nella stessa sede, ad intervallo di 1–3 mesi; 260 pazienti sono stati sottoposti ad una sola embolizzazione, 78 pazienti a due embolizzazioni e 29 pazienti a tre o più embolizzazioni. In tutti è stato usato come unico agente embolizzante l’N-2-butil-Cianoacrilato (NBCA) diluito con lipiodol al 33%.

Risultati

Quattrocentodiccianove embolizzazioni (93%) sono state portate a termine con successo. Si è ottenuta risposta clinica in 406 procedure (97%) e nessuna risposta in 13 procedure in pazienti con tumori del bacino e del sacro. In 35 pazienti non è stata eseguita alcuna embolizzazione: in 21 pazienti con metastasi e in 2 con cisti aneurismatiche per scarsa vascolarizzazione; in 4 con metastasi ossea ed in 1 con cisti aneurismatica per la presenza di arteria di Adamkiewicz nella vascolarizzazione della lesione; in 5 pazienti con metastasi ossee per problemi steno-ostruttivi su base ateromasica; in 2 pazienti con metastasi per problemi tecnici legati al calibro dei vasi. Per quanto riguarda le complicazioni, in 81 pazienti (22%) è stata osservata una sindrome post-embolica, in 41 pazienti (11%) paresi transitoria, in cinque pazienti (1,4%) necrosi cutanea e sottocutanea di spala e pelvi, e in un paziente (0,3%) è stata riscontrata una paresi transitoria del nervo sciatico.

Conclusioni

Raccomandiamo l’embolizzazione per tumori ossei di varia istologia come trattamento primario, adiuvante o palliativo. È fondamentale un rigorosa adesione ai principi delle tecniche di embolizzazione. I vasi afferenti alla lesione vanno attentamente valutati e cateterizzati in maniera altamente selettiva al fine di proteggere i tessuti non lesionali. L’NBCA è, a nostro avviso, l’agente embolizzante più adatto per l’occlusione di piccoli vasi in assenza di complicanze maggiori, ma richiede buona esperienza da parte degli operatori.

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Author information

Affiliations

  1. Department of Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy

    G. Rossi

  2. Department of Orthopaedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    A. F. Mavrogenis, C. Errani, P. Ruggieri & M. Mercuri

  3. Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy

    E. Rimondi

  4. Department of Radiology, Ospedale Sant’ Orsola, Bologna, Italy

    F. Ciccarese

  5. Department of Nuclear Medicine, Maggiore Hospital, Bologna, Italy

    C. Tranfaglia

  6. Unita Operativa di Oncologia, Ospedale Sant’ Orsola, Bologna, Italy

    B. Angelelli

  7. Istituto Toscano Tumori, Nuovo Ospedale San Giuseppe, Empoli, Italy

    G. Fiorentini

  8. Poliambulatorio di Radiologia Zappi, Bartalena, Imola, Italy

    T. Bartalena

Authors
  1. G. Rossi
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  2. A. F. Mavrogenis
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  3. E. Rimondi
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  4. F. Ciccarese
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  5. C. Tranfaglia
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  6. B. Angelelli
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  7. G. Fiorentini
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  8. T. Bartalena
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  9. C. Errani
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  10. P. Ruggieri
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  11. M. Mercuri
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Corresponding author

Correspondence to P. Ruggieri.

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Rossi, G., Mavrogenis, A.F., Rimondi, E. et al. Selective arterial embolisation for bone tumours: experience of 454 cases. Radiol med 116, 793–808 (2011). https://doi.org/10.1007/s11547-011-0670-0

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  • DOI: https://doi.org/10.1007/s11547-011-0670-0

Keywords

  • Selective embolization
  • NBCA
  • Bone tumours

Parole chiave

  • Embolizzazione arteriosa selettiva
  • NBCA
  • Tumori ossei