Interventional Radiology in the Management of Metastases and Bone Tumors

Abstract

Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to −40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.

Cement leakage during vertebroplasty: comparison between intact and wall disruption in spinal metastases

“…Several techniques have been described to minimize cement leakage during PVP, such as the use of balloon catheters to control cement flow or the use of polyetheretherketone (PEEK) coiled metallic implants (6). Some authors use combined techniques with ablation in association with cement injection for the treatment of bone fracture and impending fracture (21). Such combined techniques might have a positive impact on the cement leakage rate and should be evaluated.…”

Comparing the efficacy and safety of cryoablation and microwave ablation in treating paravertebral metastases of rabbit VX2 tumor

“…In recent years, the incidence of malignant tumors has witnessed a notable increase, and a majority of advanced malignant tumors tend to metastasize. When metastatic tumors are situated in the paravertebral region, they frequently induce severe pain and motor dysfunction in patients 1,2 Paravertebral metastatic tumors, due to their unique anatomical location, involve the paravertebral bone cortex, periosteum, and surrounding soft tissues, which harbor a greater density of sensory nerve endings.…”

The diagnostic value of machine learning for the classification of malignant bone tumor: a systematic evaluation and meta-analysis

“…Currently, the diagnostic modalities for malignant bone tumors mainly encompass imaging examinations, histological examinations, and laboratory tests ( 4 ). Imaging examinations include X-ray, CT, MRI, bone scan, etc., which can provide information about bone morphology, structure, density, and metabolism ( 5 ). Histological examinations help determine the tissue type of lesions by tissue biopsy or cytologic examination, consisting of needle biopsy, puncture biopsy, and surgical excision of tissue ( 6 ).…”