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Palliative embolisation for advanced bone sarcomas

Embolizzazione palliativa per i sarcomi ossei in fase avanzata

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

Purpose

Managing patients with advanced bone sarcomas — namely, recurrent, unresectable and metastatic — is mostly aimed at palliation. The role of embolisation for pain relief for these patients has not been previously reported. We therefore performed this study to emphasise the palliative role of embolisation for pain relief of advanced bone sarcoma patients.

Materials and methods

We retrospectively studied 43 patients with advanced bone sarcomas treated with palliative embolisation with N-2-butyl-cyanoacrylate from 2004 to 2011. All patients had primary treatments including chemotherapy, radiation therapy, radiofrequency thermal ablation, and/or surgery for their advanced sarcomas and were referred for embolisation as end-stage treatment for continuous severe local pain. The effect of embolisation was evaluated with a pain score scale and analgesic use. Mean follow-up was 7 (range, 1–19) months); all patients were dead at the last follow-up.

Results

In all patients, angiography showed increased pathological vascularisation of the sarcomas; three to six feeding vessels were embolised in each procedure. Almost complete pain relief and >50% reduction in analgesic use was experienced by 36 patients with highly hypervascular sarcomas and sarcomas in the pelvis and shoulder girdle. Moderate pain relief and 50% reduction in analgesic use was experienced by seven patients with spinal and sacral lesions. Within the available follow-up, no patient had recurrent pain with the same intensity as before embolisation. All patients experienced ischaemic pain at the site of embolisation that resolved completely with analgesics. Six patients with advanced pelvic bone sarcomas experienced paraesthesias at the distribution of the sciatic nerve that resolved completely with methylprednisolone.

Conclusions

Embolisation is a safe and effective local palliative treatment for patients with advanced sarcomas, providing optimum pain relief with the least discomfort and the possibility of minor complications only.

Riassunto

Obiettivo

La gestione dei pazienti con i sarcomi dell’osso in fase avanzata, cioè ricorrenti, non resecabili e metastatici, è volta prevalentemente alla palliazione. Il ruolo dell’embolizzazione nel sollievo dal dolore per questi pazienti non è stato riportato in precedenza. Abbiamo quindi svolto questo studio per enfatizzare il ruolo palliativo dell’embolizzazione nella riduzione del dolore dei pazienti con sarcomi dell’osso in fase avanzata.

Materiali e metodi

Abbiamo studiato retrospettivamente 43 pazienti con sarcomi dell’osso in fase avanzata trattati con embolizzazione palliativa mediante N-2-butil-cianoacrilato dal 2004 al 2011. Tutti i pazienti sono stati sottoposti ad un trattamento di prima linea che includeva chemioterapia, radioterapia, termoablazione con radiofrequenza e/o chirurgia per sarcomi in fase avanzata, e sono stati successivamente trattati con l’embolizzazione come trattamento finale per il dolore locale severo e continuo. Gli effetti dell’embolizzazione sono stati valutati con una scala del dolore e con l’uso di analgesici. Il follow-up medio è stato di 7 mesi (range 1–19 mesi); tutti i pazienti sono deceduti all’ultimo follow-up.

Risultati

In tutti i pazienti l’angiografia mostrava un aumento della vascolarizzazione patologica del sarcoma; da tre a sei vasi afferenti sono stati embolizzati durante ogni procedura. Trentasei pazienti con sarcomi altamente ipervascolarizzati, sarcomi della pelvi e del cingolo scapolare sono andati incontro ad una quasi completa risoluzione del dolore e ad una riduzione dell’uso di analgesici maggiore del 50%. Nel corso del follow-up nessun paziente ha lamentato la ricomparsa del dolore con intensità pari a quella presente prima dell’embolizzazione. Tutti i pazienti hanno manifestato un dolore di tipo ischemico in sede di embolizzazione che si è completamente risolto con l’assunzione di analgesici. Sei pazienti con sarcomi pelvici dell’osso in fase avanzata hanno lamentato la comparsa di parestesie nel territorio di distribuzione del nervo sciatico che si sono completamente risolte con l’assunzione di metilprednilsolone.

Conclusioni

L’embolizzazione è un trattamento palliativo locale sicuro ed efficace per i pazienti con sarcomi ossei in fase avanzata, garantendo un’ottimale risoluzione del dolore, un minimo disagio ed una minor incidenza di complicanze.

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Authors and Affiliations

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

    A. F. Mavrogenis, T. Calabrò, A. Angelini & P. Ruggieri

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

    G. Rossi

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

    G. Altimari

  4. Department of Anesthesiology, S. Orsola-Malpighi University Hospital, Bologna, Italy

    E. Rimondi

  5. Deparment of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

    E. Palmerini

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

    G. Rossi

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  1. A. F. Mavrogenis
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  2. G. Rossi
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  7. E. Rimondi
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  8. P. Ruggieri
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Correspondence to G. Rossi.

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Mavrogenis, A.F., Rossi, G., Altimari, G. et al. Palliative embolisation for advanced bone sarcomas. Radiol med 118, 1344–1359 (2013). https://doi.org/10.1007/s11547-012-0868-3

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  • DOI: https://doi.org/10.1007/s11547-012-0868-3

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