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Palliative embolization for osteosarcoma

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The prognosis of patients with metastatic, recurrent, and/or unresectable osteosarcoma is poor. Aggressive local and medical treatments are available for palliation. Palliative treatments include isolated limb perfusion, radiation therapy, embolization, chemoembolization, thermal ablation, and cryoablation. Their aim is pain relief and tumor size reduction with minimum complications.

Materials and methods

We present 19 patients with metastatic, recurrent, and/or unresectable osteosarcoma of the pelvis and lower lumbar spine treated with palliative selective embolization using N-2-butyl cyanoacrylate. All patients had chemotherapy. At the time of embolization, they experienced severe pain refractory to analgesics. Diagnostic angiography was performed pre-embolization to determine the vascular mapping and hemodynamic status of the tumor. Post-embolization angiography was done to evaluate for complete occlusion of the pathological vessels. Mean follow-up was 18 months. Local pain, tumor necrosis and size, and complications were recorded.

Results

In all patients, pre-embolization angiography showed hypervascularity of the tumor from extensive neovascularization. Five patients had repeat embolization. All patients experienced pain relief at a mean of 3 days post-embolization. No patient had recurrent pain with the intensity of that before embolization. Variable tumor necrosis was observed in follow-up imaging, and reduction in tumor size was minimum. All patients experienced pain at the site of embolization, which resolved completely 1–5 days after embolization. Four patients with pelvic osteosarcomas experienced paraesthesias at the distribution of the sciatic nerve.

Conclusion

Selective arterial embolization is a useful local palliative treatment for patients with advanced osteosarcoma for pain relief.

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Conflict of interest

None of the authors have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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Authors and Affiliations

  1. First Department of Orthopaedics, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece

    Andreas F. Mavrogenis & Panayiotis J. Papagelopoulos

  2. Department of Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Rossi

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

    Eugenio Rimondi

  4. Department of Orthopaedics, Istituto Ortopedico Rizzoli, Bologna, Italy

    Teresa Calabrò & Pietro Ruggieri

Authors
  1. Andreas F. Mavrogenis
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  2. Giuseppe Rossi
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  3. Eugenio Rimondi
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  4. Teresa Calabrò
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  5. Panayiotis J. Papagelopoulos
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  6. Pietro Ruggieri
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Correspondence to Andreas F. Mavrogenis.

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Mavrogenis, A.F., Rossi, G., Rimondi, E. et al. Palliative embolization for osteosarcoma. Eur J Orthop Surg Traumatol 24, 1351–1356 (2014). https://doi.org/10.1007/s00590-013-1312-0

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  • DOI: https://doi.org/10.1007/s00590-013-1312-0

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