Interventional radiology in bone metastases

Abstract

Interventional radiology plays a significant role in the treatment of bone metastases by various techniques, percutaneous or endovascular. Vertebroplasty is the most well-studied technique for stabilisation of spine metastases as it induces satisfactory stabilisation of the vertebra and offers clear improvement of the quality of life. Due to the success of this technique cementoplasty of other bones, mainly pelvic girdle, has been largely developed. The development of reinforced cementoplasty allows treatment of pre-fractural osteolysis of some long bones. The heat due to the polymerisation of the cement induces carcinolytic effect but this effect is not as important as that which results from radiofrequency destruction. This last technique appears currently as the most important development to definitively destroy bone metastases and is progressively replacing percutaneous alcoholic destruction of such lesions. Angiographic techniques, such as endovascular embolisation, can also be very useful to reduce the risk of surgical treatment of hyper vascular metastases. Chemoembolisation is currently developed to associate pain relief induced by Endovascular embolisation and the carcinolytic effect obtained by local endovascular chemotherapy. All these techniques should develop largely during the next years.

Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group

“…This procedure if used alone is likely to be of limited value initially for vertebral disease with epidural extension and/or spinal cord compression as there is a small risk of further displacing the tumor into the spinal canal, causing neurologic deterioration (31,32). When patients are properly selected, the risks of tumor extravasation into the spinal canal or cement leakage into the epidural space following vertebroplasty are rare complications, limited to case reports (30)(31)(32)(33). Performing vertebroplasty after RT is a good strategy to reduce these risks since RT would reduce the tumor bulk and potentially induce remineralization.…”

Understanding the Progression of Bone Metastases to Identify Novel Therapeutic Targets

“…Interventional radiology uses several techniques (cementoplasty, radiofrequency ablation, cryotherapy, chemoembolization) to achieve bone consolidation with varying degrees of tumour cells destruction [ 74 , 75 ].…”

Efficiency and Advantages of Percutaneous Femoroplasty versus Proximal Femoral Replacement for Proximal Femur Metastases

“…The management of bone metastases requires a multidisciplinary staff who can administer systemic "non-invasive" treatments like radiotherapy, chemotherapy, targeted therapy, and bisphosphonates [2] [3] [4] [5] [6]. However, these "non-invasive" therapeutic regimens leave a high percentage of patients with inadequate or undermanaged pain control [7] [8] [9].…”

“…However, these "non-invasive" therapeutic regimens leave a high percentage of patients with inadequate or undermanaged pain control [7] [8] [9]. Therefore, "invasive" and "mini-invasive" treatments for proximal femur metastases have been recommended and demonstrated to be effective for controlling cancer-related pain [2] [10] [11] [12]. As we known, a minimally invasive therapeutic option has specific advantages, and an effective and minimally invasive surgical technique are desired for managing advanced cancer patients with severe bone pain who cannot tolerate major surgery or in patients in whom radiotherapy already has been ineffective and who therefore have only the goal of pain relief.…”