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Embolisation of bone metastases from renal cancer

Embolizzazione delle metastasi ossee da carcinoma renale

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
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Abstract

Purpose

This study was done to evaluate embolisation for palliative and/or adjuvant treatment of bone metastases from renal cell carcinoma and discuss the clinical and imaging results.

Materials and methods

We retrospectively studied 107 patients with bone metastases from renal cell carcinoma treated from December 2002 to January 2011 with 163 embolisations using N-2-butyl cyanoacrylate (NBCA). Mean tumour diameter before embolisation was 8.8 cm and mean follow-up 4 years. Clinical and imaging effects of treatment were evaluated at follow-up examinations with a pain score scale, analgesic use, hypoattenuating areas, tumour size and ossification.

Results

A clinical response was achieved in 157 (96%) and no response in six embolisations of sacroiliac metastases. Mean duration of clinical response was 10 (range 1–12) months. Hypoattenuating areas resembling tumour necrosis were observed in all patients. Variable ossification appeared in 41 patients. Mean maximal tumour diameter after embolisation was 4.0 cm. One patient had intraprocedural tear of the left L3 artery and iliopsoas haemorrhage and was treated with occlusion of the bleeding vessel with NBCA. All patients had variable ischaemic pain that recovered completely within 2–4 days. Postembolisation syndrome was diagnosed after 15 embolisations (9.2%). Transient paraesthesias in the lower extremities were observed after 25 embolisations (25%) of pelvis and sacrum metastatic lesions.

Conclusions

Embolisation with NBCA is recommended as primary or palliative treatment of bone metastases from renal cell carcinoma. Strict adherence to the principles of transcatheter embolisation is important to avoid complications.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare l’embolizzazione come trattamento palliativo e/o adiuvante delle metastasi ossee da carcinoma a cellule renali e discuterne i risultati clinici e radiologici.

Materiali e metodi

Abbiamo studiato retrospettivamente 107 pazienti con metastasi da carcinoma renale trattati con 163 embolizzazioni con N-2-butil ciano-acrilato (NBCA) da dicembre 2002 a gennaio 2011. Il diametro medio tumorale prima dell’embolizzazione era di 8,8 cm. La media dei follow-up era di di 4 anni. Gli effetti clinici e radiologici sono stati valutati durante i successivi controlli con una scala di punteggio per il dolore, uso degli analgesici, aree di ipoattenuazione, dimensione del tumore ed ossificazione.

Risultati

Una risposta clinica è stata ottenuta in 157 embolizzazioni (96%) mentre non è stata ottenuta alcuna risposta in 6 embolizzazioni di metastasi alla sacro-iliaca. La durata media della risposta clinica è stata di 10 mesi (da 1 a 12 mesi). Aree di ipoattenuazione associabili a necrosi tumorale sono state osservate in tutti i pazienti. Ossificazione variabile è stata osservata in 41 pazienti. La media dei diametri tumorali dopo l’embolizzazione è stata di 4,0 cm. Un paziente ha riportato, durante la procedura, una lesione dell’arteria sinistra di L3 ed emorragia nell’ileo-psoas, è stato trattato con occlusione del vaso sanguinante con NBCA. Tutti i pazienti hanno avuto un grado variabile di dolore ischemico che è completamente scomparso in un arco di 2–4 giorni. Dopo la procedura sono stati diagnosticati 15 casi (9,2%) di sindrome post-embolizzazione. Parestesie transitorie agli arti inferiori sono state osservate dopo 25 embolizzazioni (25%) di lesioni metastatiche al sacro ed alle pelvi.

Conclusioni

L’embolizzazione con NBCA è raccomandata come trattamento sia primario che palliativo delle metastasi ossee da carcinoma renale. Una rigorosa aderenza ai principi di embolizzazione attraverso catetere è importante per evitare complicazioni.

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Authors and Affiliations

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

    G. Rossi

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

    A. F. Mavrogenis, R. Casadei, G. Bianchi, C. Romagnoli & P. Ruggieri

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

    E. Rimondi

  4. Orthopaedic Oncology Service, Department of Orthopaedics, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, 40136, Bologna, Italy

    P. Ruggieri

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  1. G. Rossi
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  2. A. F. Mavrogenis
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  3. R. Casadei
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  4. G. Bianchi
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  5. C. Romagnoli
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  7. P. Ruggieri
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Correspondence to P. Ruggieri.

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Rossi, G., Mavrogenis, A.F., Casadei, R. et al. Embolisation of bone metastases from renal cancer. Radiol med 118, 291–302 (2013). https://doi.org/10.1007/s11547-012-0802-4

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  • DOI: https://doi.org/10.1007/s11547-012-0802-4

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